Ankle Radiographs in the Early Postoperative Period

McDonald, Matthew R.; Bulka, Catherine M.; Thakore, Rachel V.; Obremskey, William T.; Ehrenfeld, Jesse M.; Jahangir, A. Alex; Sethi, Manish K.

doi:10.1097/bot.0000000000000052

Cited by 17 publications

(26 citation statements)

References 4 publications

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“…Since patients were exposed to unnecessary radiation, we believe that imaging could be delayed to a later follow-up visits in which fracture-healing needs to be assessed. We agree with the previous findings that early postoperative radiographs may not be beneficial in all ankle fracture patients, but radiographs may be indicated if the clinical picture necessitates them [3].…”

Section: Discussionsupporting

confidence: 92%

“…Early recognition of these infections is highly important because in cases with delayed diagnosis the presence of biofilm presents a highly demanding challenge for bacterial eradication and infection treatment [16,17]. A recent study with 1411 ankle fractures observed that 6.6% of ankle fracture patients had an early complication [3]. Our study showed that every tenth operatively treated ankle fracture patient required a change in treatment plan by the time of the first outpatient visit, and that 91% of the changes were exclusively due to clinical findings such as infection or cast-related issues.…”

Section: Discussionmentioning

confidence: 99%

“…Ankle fractures represent approximately 10% of all fractures and are among the most frequently surgically treated fractures [1,2]. Surgical treatment of ankle fractures may be accompanied by several complications [3,4], and the most frequently encountered complications are related to wound healing and surgical-site infections [1,4,5]. Although the incidence of malreduction observed in postoperative radiographs leading to early reoperation is low [6], it is a common practice that patients have a scheduled follow-up visit to an outpatient clinic together with radiographs following acute fracture surgery [7].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Recent studies have questioned the justification of routine radiographs obtained at the early outpatient visit [3,7], as the majority of these radiographs do not result in a change in patient management [7]. However, due to the high number of postoperative complications observed in ankle fracture patients, radiographs may be still indicated if the clinical picture necessitates them [3]. A recent study evaluating acute fractures in various anatomic locations showed that only a few patients require a deviation from the standard postoperative care at the first outpatient visit, and that the deviation is not based on the radiographs but rather on patient history and physical examination [7].…”

Section: Introductionmentioning

confidence: 99%

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The role of outpatient visit after operative treatment of ankle fractures

Ovaska

Nuutinen

Madanat

et al. 2016

Injury

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It is a common practice that patients have a scheduled follow-up visit with radiographs following ankle fracture surgery. The aim of this study was to evaluate whether an early outpatient visit (<3 weeks) after ankle fracture surgery resulted in a change in patient management. For this study, 878 consecutive operatively treated ankle fracture patients with an early outpatient clinical-radiological visit were reviewed. The outcome measure was a change in treatment plan defined as any procedure, medication, or surgical intervention that is not typically implemented during the uncomplicated healing process of an acute fracture. A change in treatment plan was observed in 9.8% of operatively treated ankle fracture patients. The mean age of the patients was 48 years and the mean follow-up time was 64 months. Of the changes in treatment plan, 91% were exclusively due to clinical findings such as infection. Only three of 878 patients required a change in their treatment plan based merely on the findings of the radiographs taken at the outpatient visit. Only 37% of the patients requiring a change in their postoperative management had solicited an unanticipated visit before the scheduled outpatient visit due to clinical problems such as infection or a cast-related issue. Our study showed that every tenth operatively treated ankle fracture patient requires a change in their treatment plan due to a clinical problem such as infection or a cast-related issue. Although at hospital discharge all patients are provided with written instructions on where to contact if problems related to the operated ankle emerge, only one third of the patients are aware of the clinically alarming symptoms and seek care when problems present. Our findings do not support obtaining routine radiographs at the early outpatient visit in an ankle fracture patient without clinical signs of a complication.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The role of outpatient visit after operative treatment of ankle fractures

Ovaska

Nuutinen

Madanat

et al. 2016

Injury

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The value of radiography in the follow-up of extremity fractures: a systematic review

Gerven

Rubinstein²,

Nederpelt

et al. 2018

Arch Orthop Trauma Surg

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BackgroundThe added value of routine radiography in the follow-up of extremity fractures is unclear. The aim of this systematic review was to create an overview of radiography use in extremity fracture care and the consequences of these radiographs for the treatment of patients with these fractures.Materials and methodsStudies were included if they reported on the use of radiography in the follow-up of extremity fractures and on its influence on treatment strategy, clinical outcome, or complications. A comprehensive search of electronic databases (i.e., PubMed, Embase, and Cochrane) was performed to identify relevant studies. Methodological quality was assessed with the Newcastle–Ottawa scale for cohort studies. Level of evidence was assessed using GRADE. The search, quality appraisal, and data extraction were performed independently by two researchers.ResultsEleven studies were included. All studies were retrospective cohorts. Of these, only two used a comparative design. Two of the included studies described fractures of both the upper and lower extremities, four studies concerned fractures of the lower extremity only, and five studies focused on fractures of the upper extremity. Pooling of data was not performed because of clinical heterogeneity. Eight studies reported on a change in treatment strategy related to radiography. Percentages ranged from 0 to 2.6%. The overall results indicated that radiographs in the follow-up of extremity fractures seldom alter treatment strategy, that the vast majority of follow-up radiographs are obtained without a clinical indication and that detection of a complication on a radiograph, in the absence of clinical symptoms, is unlikely. All included studies were regarded of a ‘very low’ level using GRADE.ConclusionsBased on current literature, the added value of routine radiography in the follow-up of extremity fractures seems limited. Results, however, should be interpreted with care, considering that available evidence is of a low level.Electronic supplementary materialThe online version of this article (10.1007/s00402-018-3021-y) contains supplementary material, which is available to authorized users.

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