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Saving time in the fracture clinic: 2 weeks post-operative plain films following open reduction and internal fixation of distal radius fractures do not affect management

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Abstract

Introduction

Distal radius fractures represent up to one in every sixth treated fracture. The majority of these are intra-articular and require operative management. Many recent studies advocate for the use of volar plating fixation. Following fixation, most patients attend the fracture clinic at 2 and 6 weeks post-operatively and may get repeat imaging at both visits, resulting in longer wait times and repeat exposure to radiation. Revision surgery is however rarely performed in the 2- to 6-week period, raising the question of the necessity of plain film at 2 weeks.

Aim

Improve patient satisfaction in the fracture clinic by reducing wait time in fracture clinic and limiting exposure to radiation.

Method

The number of distal radius open reduction and internal fixation (ORIF) over a 12-month period was retrieved using theatre logbooks. Patient details were used to check whether a plain film radiograph had been performed 2 weeks post-operatively. Subsequently, patients’ records were used to determine if revision surgery was performed or planned.

Results

In total, 123 distal radius ORIF were performed between January 2018 and January 2019. Two-week check radiographs were performed for 82 patients (67%). One patient (0.8%) underwent revision surgery following review of intra-operative imaging. No patients underwent revision ORIF following 2-week plain film.

Conclusion

Repeat imaging at 2 weeks following distal radius ORIF did not change management of distal radius fractures in this study. Therefore, our data suggests 2-week plain films should not routinely be ordered for these patients which will reduce wait time and exposure to radiation.

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Data availability

Data available for review on request.

References

  1. Meena S, Sharma P, Sambharia AK, Dawar A (2014) Fractures of distal radius: an overview. J Family Med Prim Care 3(4):325–332

    Article  Google Scholar 

  2. Toon DH, Premchand RAX, Sim J, Vaikunthan R (2017) Outcomes and financial implications of intra-articular distal radius fractures: a comparative study of open reduction internal fixation (ORIF) with volar locking plates versus nonoperative management. J Orthop Traumatol 18(3):229–234

    Article  Google Scholar 

  3. Pedersen J, Mortensen SO, Rolfing JD, Thorninger R (2019) A protocol for a single-center, single-blinded randomized-controlled trial investigating volar plating versus conservative treatment of unstable distal radius fractures in patients older than 65 years. BMC Musculoskelet Disord 20(1):309

    Article  Google Scholar 

  4. Chung KC, Shauver MJ, Birkmeyer JD (2009) Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg Am 91(8):1868–1873

    Article  Google Scholar 

  5. Thorninger R, Madsen ML, Waever D et al (2017) Complications of volar locking plating of distal radius fractures in 576 patients with 3.2 years follow-up. Injury 48(6):1104–1109

    Article  Google Scholar 

  6. Lozano-Calderon SA, Souer S, Mudgal C et al (2008) Wrist mobilization following volar plate fixation of fractures of the distal part of the radius. J Bone Joint Surg Am 90(6):1297–1304

    Article  Google Scholar 

  7. British Orthopaedic Association and British Society for Surgery of the Hand (2018) Best practice for management of distal radial fractures, ed. Bri Soc Surg Hand 10-11:35–46

    Google Scholar 

  8. Lichtman DM, Bindra RR, Boyer MI et al (2010) Treatment of distal radius fractures. J Am Acad Orthop Surg 18(3):180–189

    Article  Google Scholar 

  9. Mattila VM, Huttunen TT, Sillanpaa P et al (2011) Significant change in the surgical treatment of distal radius fractures: a nationwide study between 1998 and 2008 in Finland. J Trauma 71(4):939–942 discussion 942-3

    PubMed  Google Scholar 

  10. Koval KJ, Harrast JJ, Anglen JO, Weinstein JN (2008) Fractures of the distal part of the radius. The evolution of practice over time. Where’s the evidence? J Bone Joint Surg Am 90(9):1855–1861

    Article  Google Scholar 

  11. Capo JT, Kinchelow T, Brooks K et al (2009) Biomechanical stability of four fixation constructs for distal radius fractures. Hand (N Y) 4(3):272–278

    Article  Google Scholar 

  12. Dahl WJ, Nassab PF, Burgess KM et al (2012) Biomechanical properties of fixed-angle volar distal radius plates under dynamic loading. J Hand Surg [Am] 37(7):1381–1387

    Article  Google Scholar 

  13. van Gerven P, El Moumni M, Zuidema WP et al (2019) Omitting routine radiography of traumatic distal radial fractures after initial 2-week follow-up does not affect outcomes. J Bone Joint Surg Am 101(15):1342–1350

    Article  Google Scholar 

  14. Radiological Society of North America. Radiation dose in X-Ray and CT exams. Updated March 2019 Accessed 28 August 2019]; Available from: https://www.radiologyinfo.org/en/pdf/safety-xray.pdf

  15. Ghattas TN, Dart BR, Pollock AG et al (2013) Effect of initial postoperative visit radiographs on treatment plans. J Bone Joint Surg Am 95(9):e57 S1

    Article  Google Scholar 

  16. Karl JW, Swart E, Strauch RJ (2015) Diagnosis of occult scaphoid fractures: a cost-effectiveness analysis. J Bone Joint Surg Am 97(22):1860–1868

    Article  Google Scholar 

  17. Rubin GD (2017) Costing in radiology and health care: rationale, relativity, rudiments, and realities. Radiology 282(2):333–347

    Article  Google Scholar 

  18. Stiell I, Wells G, Laupacis A et al (1995) Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injuries. Multicentre Ankle Rule Study Group. Bmj 311(7005):594–597

    Article  CAS  Google Scholar 

  19. Weil NL, El Moumni M, Rubinstein SM et al (2017) Routine follow-up radiographs for distal radius fractures are seldom clinically substantiated. Arch Orthop Trauma Surg 137(9):1187–1191

    Article  CAS  Google Scholar 

  20. Huffaker S, Earp BE, Blazar PE (2015) The value of post-operative radiographs in clinical management of AO type A distal radius fractures. J Hand Surg Eur Vol 40(8):790–795

    Article  CAS  Google Scholar 

  21. Stone JD, Vaccaro LM, Brabender RC, Hess AV (2015) Utility and cost analysis of radiographs taken 2 weeks following plate fixation of distal radius fractures. J Hand Surg [Am] 40(6):1106–1109

    Article  Google Scholar 

  22. Tarallo L, Mugnai R, Zambianchi F et al (2013) Volar plate fixation for the treatment of distal radius fractures: analysis of adverse events. J Orthop Trauma 27(12):740–745

    Article  Google Scholar 

  23. Oehme F, Link BC, Frima H et al (2018) Is there a need for standardized postoperative radiographs after operative treatment of wrist or ankle fractures? Eur J Trauma Emerg Surg 45(6):1039–1044

    Article  Google Scholar 

  24. Ng CY, McQueen MM (2011) What are the radiological predictors of functional outcome following fractures of the distal radius? J Bone Joint Surg (Br) 93(2):145–150

    Article  CAS  Google Scholar 

  25. Bohl DD, Lese AB, Patterson JT et al (2014) Routine imaging after operatively repaired distal radius and scaphoid fractures: a survey of hand surgeons. J Wrist Surg 3(4):239–244

    Article  Google Scholar 

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Correspondence to Quentin W. A. Jeantet.

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Jeantet, Q.W.A., Coveney, E.I. & O’Daly, B.J. Saving time in the fracture clinic: 2 weeks post-operative plain films following open reduction and internal fixation of distal radius fractures do not affect management. Ir J Med Sci 190, 1041–1044 (2021). https://doi.org/10.1007/s11845-020-02420-2

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  • DOI: https://doi.org/10.1007/s11845-020-02420-2

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