Advertisement

Is there a need for standardized postoperative radiographs after operative treatment of wrist or ankle fractures?

  • Florian Oehme
  • Björn Christian Link
  • Herman Frima
  • Tim Schepers
  • Steven J. Rhemrev
  • Reto Babst
  • Frank J. P. Beeres
Original Article
  • 56 Downloads

Abstract

Purpose

The purpose of this study was to evaluate the frequency of changes in treatment plan due to standardized postoperative radiographs. A secondary aim was to compare our results with a national benchmark.

Methods

This is a single-center retrospective case series of 167 consecutive patients, operated with open reduction and internal fixation (ORIF) for distal radius or ankle fractures in 2014. Changes in the treatment protocol were defined as additional CT-imaging, reoperation or other changes as stated in the postoperative instructions. In addition, a national survey was conducted assessing differences between surgeons in different hospitals concerning revision rates.

Results

In 7.2% (12/167) of the patients, a change in the treatment plan was recorded after the standardized postoperative radiographs. 10 patients (6%) were reoperated (three without additional imaging, seven after additional imaging with CT). The results from our survey showed a good assessment concerning the quality of intraoperative imaging (7.85 on a scale from 0 to 10). Concerning the revision rate, there was a trend to lower revision rate of 8.1% in the six observers.

Conclusions

Standard postoperative radiographs could improve quality of care. Intraoperative standardized radiographic documentation is needed and the perception and acceptance of quality may vary between hospitals.

Keywords

Radius fracture Ankle fracture Postoperative radiograph Treatment plan change 

Notes

Acknowledgements

We would like to acknowledge N. Ruzza, C. Michelitsch, J.Winkler and M.Alnaib for their help and input.

Compliance with ethical standards

Conflict of interest

F. Oehme, B. C. Link, H. Frima, T. Schepers, S. J. Rhemrev, R. Babst and F. J. P. Beeres declare that they have no conflict of interest.

Research involving human participants and/or animals

No animals were included in this trial.

Informed consent

There was no informed consent requested in this trial. No personal or confidential data were included in this analysis.

References

  1. 1.
    Bott OJ, Dresing K, Wagner M, Raab BW, Teistler M. Informatics in radiology: use of a C-arm fluoroscopy simulator to support training in intraoperative radiography. Radiographics. 2011;31:E65–75.CrossRefPubMedGoogle Scholar
  2. 2.
    Blattert TR, Fill UA, Kunz E, Panzer W, Weckbach A, Regulla DF. Skill dependence of radiation exposure for the orthopaedic surgeon during interlocking nailing of long-bone shaft fractures: a clinical study. Arch Orthop Trauma Surg Archiv fur orthopadische und Unfall-Chirurgie. 2004;124:659–64.CrossRefGoogle Scholar
  3. 3.
    Haddad FS, Williams RL, Prendergast CM. The check X-ray: an unnecessary investigation after hip fracture fixation? Injury. 1996;27:351–2.CrossRefPubMedGoogle Scholar
  4. 4.
    Harish S, Vince AS, Patel AD. Routine radiography following ankle fracture fixation: a case for limiting its use. Injury. 1999;30:699–701.CrossRefPubMedGoogle Scholar
  5. 5.
    Pattison RM, Calzada S, Koka SR, James SE. Postoperative radiographs or thermal prints after internal fixation of fractures? A study of DHS fixation of hip fractures. Ann R Coll Surg Engl. 1996;78:509–11.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Chakravarthy J, Mangat K, Qureshi A, Porter K. Postoperative radiographs following hip fracture surgery. Do they influence patient management? Int J Clin Pract. 2007;61:421–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Tufescu T. The cost of screening radiographs after stable fracture fixation. Can J Surg J Canadien de Chirurgie. 2017;60:53–6.Google Scholar
  8. 8.
    Stone JD, Vaccaro LM, Brabender RC, Hess AV. Utility and cost analysis of radiographs taken 2 weeks following plate fixation of distal radius fractures. J Hand Surg. 2015;40:1106–9.CrossRefGoogle Scholar
  9. 9.
    Seeley DG, Kelsey J, Jergas M, Nevitt MC. Predictors of ankle and foot fractures in older women. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res. 1996;11:1347–55.CrossRefPubMedGoogle Scholar
  10. 10.
    Spaine LA, Bollen SR. ‘The bigger they come … the relationship between body mass index and severity of ankle fractures. Injury. 1996;27:687–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Tinubu J, Scalea TM. Management of fractures in a geriatric surgical patient. Surg Clin N Am. 2015;95:115–28.CrossRefPubMedGoogle Scholar
  12. 12.
    Tufescu T. Working toward reducing postoperative fracture radiographs: a survey of Canadian surgeons. Can J Surg J Canadien de Chirurgie. 2016;59:26–8.CrossRefGoogle Scholar
  13. 13.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–9.CrossRefGoogle Scholar
  14. 14.
    Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Jt Surg Am Vol. 1976;58:453–8.CrossRefGoogle Scholar
  15. 15.
    Tarallo L, Mugnai R, Zambianchi F, Adani R, Catani F. Volar plate fixation for the treatment of distal radius fractures: analysis of adverse events. J Orthop Trauma. 2013;27:740–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Stockle U, Konig B, Dahne M, Raschke M, Haas NP. Computer assisted pelvic and acetabular surgery. Clinical experiences indications. Unfallchirurg. 2002;105:886–92.CrossRefPubMedGoogle Scholar
  17. 17.
    Atesok K, Finkelstein J, Khoury A, et al. The use of intraoperative three-dimensional imaging (ISO-C-3D) in fixation of intraarticular fractures. Injury. 2007;38:1163–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Carelsen B, Haverlag R, Ubbink DT, Luitse JS, Goslings JC. Does intraoperative fluoroscopic 3D imaging provide extra information for fracture surgery? Arch Orthop Traum Surg Archiv fur Orthopadische und Unfall-Chirurgie. 2008; 128: 1419–24.CrossRefGoogle Scholar
  19. 19.
    Geerling J, Kendoff D, Citak M, et al. Intraoperative 3D imaging in calcaneal fracture care-clinical implications and decision making. J Trauma. 2009;66:768–73.CrossRefPubMedGoogle Scholar
  20. 20.
    Ruan Z, Luo CF, Zeng BF, Zhang CQ. Percutaneous screw fixation for the acetabular fracture with quadrilateral plate involved by three-dimensional fluoroscopy navigation: surgical technique. Injury. 2012;43:517–21.CrossRefPubMedGoogle Scholar
  21. 21.
    Edwards CC 2nd, Haraszti CJ, McGillivary GR, Gutow AP. Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction. J Hand Surg. 2001;26:1036–41.CrossRefGoogle Scholar
  22. 22.
    Ruch DS, Vallee J, Poehling GG, Smith BP, Kuzma GR. Arthroscopic reduction versus fluoroscopic reduction in the management of intra-articular distal radius fractures. Arthroscopy. 2004;20:225–30.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopedic and Trauma SurgeryCantonal Hospital LucerneLucerneSwitzerland
  2. 2.Department of SurgeryCantonal Hospital GraubündenChurSwitzerland
  3. 3.Department of Surgery—TraumatologyAmsterdam Medical CentreAmsterdamThe Netherlands
  4. 4.Department of SurgeryMedical Center HaaglandenThe HagueThe Netherlands

Personalised recommendations