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Utility of Routine Postoperative Radiographs After Fixation of Lower Extremity Fractures

Phelps, Kevin, MD; Coleman, Michelle, MD, PhD; Seymour, Rachel, PhD; Bosse, Michael, MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: November 15, 2018 - Volume 26 - Issue 22 - p 799–808
doi: 10.5435/JAAOS-D-17-00114
Research Article

Introduction: The goal of this study was to investigate the clinical utility of radiographs at all time points after internal fixation of lower extremity fractures.

Methods: A retrospective chart review was conducted at a level I trauma center. Four hundred eighty-five patients with 586 fractures of the femur, tibia, and ankle were included. Data were analyzed to investigate the effect of radiographs on changes in management at all postoperative time points for each fracture type.

Results: Each fracture received, on average, 4.8 radiographs after fixation for a total cost of $938,469. The management of 31% (179 of 586) of fractures deviated from the expected postoperative course. Of the 179 fractures with a deviation, 93 (31%) resulted from radiographic findings alone and occurred (1) in the immediate postoperative period (2%) and (2) in the period from consideration of advancement to full weight bearing up until confirmation of fracture union (98%). Notable cost savings can be realized by using the findings to eliminate nonclinically indicated imaging at both the institutional and national levels.

Conclusion: Routine radiographs in isolation contribute to changes in management (1) in the immediate postoperative period in select cases and (2) during the period when advancement to full weight bearing is being considered up until clinical fracture union.

Level of Evidence: Level III

From the Carolinas Medical Center, Charlotte, NC (Dr. Phelps, Dr. Seymour, and Dr. Bosse), and Baylor College of Medicine, Houston, TX (Dr. Coleman).

Correspondence to Dr. K. Phelps: kevin.d.phelps@gmail.com

Dr. Bosse or an immediate family member has stock or stock options held in Orthopaedic Implant Company. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Phelps, Dr. Coleman, and Dr. Seymour.

© 2018 by American Academy of Orthopaedic Surgeons
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