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Is there a need for standardized postoperative X-rays after operative treatment of clavicular fractures?



In most hospitals, acquiring postoperative X-rays after operative treatment of a fracture is the standard. Its value, however, after operative treatment for clavicular fractures is questionable. The aim of this study was to evaluate how often there is a change in treatment plan due to the postoperative X-ray after operative treatment of clavicular fractures when intra-operative images were acquired.


This was a retrospective cohort study performed in a level I trauma center. All consecutive patients treated surgically for clavicular fractures between 2014 and 2018 were included. The primary outcome was any deviation from the standard postoperative protocol resulting from the routine postoperative X-ray taken within the first 72 h after surgery. Secondary outcomes included all other complications and re-interventions performed during follow-up of patients with at least 6-month follow-up.


In total, 241 patients were included in the study with a mean age of 42 years (SD 17). Only one patient had an abnormality on postoperative X-ray necessitating additional CT-scanning. No additional re-interventions or deviations from standard postoperative protocol were required.

For secondary analyses, 187 patients were available. Seven patients had a late implant associated infection: one was detected at the time of implant removal and six during revision for non-union. Six patients had aseptic complications: four with non-union and two with implant failure. One-hundred and seven patients had an implant removal due to irritation after consolidation.


Routinely performing postoperative X-rays after osteosynthesis for clavicular fractures seems unnecessary. Refraining from performing unnecessary radiographs will decrease exposure to radiation and likely have a beneficial effect on costs, length of hospital stay as well as healthcare consumption. This study was performed in a single center; therefore, it remains to be seen whether the findings are reproducible in another setting.

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  1. 1.

    Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002;11(5):452–6.

    Article  Google Scholar 

  2. 2.

    Nair S, Nambiar M, Pope A, Parkes M, De Jong K, Hau R. Intraoperative fluoroscopy alone versus routine post-operative X-rays in identifying return to theatre after fracture fixation. ANZ J Surg. 2021.

  3. 3.

    Jennewine B, Fiorino D, Kew M, Byrne A, Yarboro S. Routine postoperative radiographs after tibia plateau fixation have minimal impact on patient care. Injury. 2019;50(11):2093–6.

    CAS  Article  Google Scholar 

  4. 4.

    Oehme F, Rühle A, Mühlhäusser J, Fourie L, Link BC, Babst R, et al. Are routine radiographs needed the day after open reduction and internal fixation surgery for distal radius and ankle fractures: study protocol for a prospective, open label, randomized controlled trial. JMIR Res Protoc. 2017;6(8):e159.

  5. 5.

    Oehme F, Link BC, Frima H, Schepers T, Rhemrev SJ, Babst R, et al. Is there a need for standardized postoperative radiographs after operative treatment of wrist or ankle fractures? Eur J Trauma Emerg Surg. 2019;45(6):1039–44.

    Article  Google Scholar 

  6. 6.

    Kuorikoski JM, Söderlund TP. Evaluation of a routine follow-up visit after an internal fixation of proximal femoral fracture. Injury. 2017;48(2):432–5.

    Article  Google Scholar 

  7. 7.

    Ghattas TN, Dart BR, Pollock AG, Hinkin S, Pham A, Jones TL. Effect of initial postoperative visit radiographs on treatment plans. J Bone Joint Surg Am. 2013;95(9):e57, S1.

  8. 8.

    Tufescu T. The cost of screening radiographs after stable fracture fixation. Can J Surg. 2017;60(1):53–6.

    Article  Google Scholar 

  9. 9.

    Shubert DJ, Shepet KH, Kerns AF, Bramer MA. Postoperative chest radiograph after open reduction internal fixation of clavicle fractures: a necessary practice? J Shoulder Elbow Surg. 2019;28(5):e131–6.

    Article  Google Scholar 

  10. 10.

    Keats AS. The ASA classification of physical status–a recapitulation. Anesthesiology. 1978;49(4):233–6.

    CAS  Article  Google Scholar 

  11. 11.

    ATLS, Advanced Trauma Life Support; Student Course Manual. Chicago2018.

  12. 12.

    Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma. 2018;32(Suppl 1):S1–170.

    Article  Google Scholar 

  13. 13.

    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 Joint Surg Am. 1976;58(4):453–8.

    CAS  Article  Google Scholar 

  14. 14.

    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27(2):97–132; quiz 3–4; discussion 96.

  15. 15.

    Whelan DB, Bhandari M, McKee MD, Guyatt GH, Kreder HJ, Stephen D, et al. Interobserver and intraobserver variation in the assessment of the healing of tibial fractures after intramedullary fixation. J Bone Joint Surg Br. 2002;84(1):15–8.

    CAS  Article  Google Scholar 

  16. 16.

    Hammer RR, Hammerby S, Lindholm B. Accuracy of radiologic assessment of tibial shaft fracture union in humans. Clin Orthop Relat Res. 1985;199:233–8.

    Google Scholar 

  17. 17.

    Rikli D, Goldhahn S, Blauth M, Mehta S, Cunningham M, Joeris A, et al. Optimizing intraoperative imaging during proximal femoral fracture fixation—a performance improvement program for surgeons. Injury. 2018;49(2):339–44.

    Article  Google Scholar 

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There was no external source of funding for this study.

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Correspondence to Isabelle R. Buenter.

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Conflict of interest

Isabelle R. Buenter, Valerie Kremo, Philipp Schelber, Nicole M. van Veelen, Nadine Diwersi, Matthias Knobe, BC Link, Reto Babst, Frank JP Beeres, Bryan J.M. van de Wall declare that they have no conflict of interest.

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

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Buenter, I.R., Kremo, V., Schelbert, P. et al. Is there a need for standardized postoperative X-rays after operative treatment of clavicular fractures?. Eur J Trauma Emerg Surg (2021).

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  • Clavicular fracture
  • Clavicle fractures
  • Postoperative X-ray
  • Postoperative radiograph
  • Treatment plan change