Do Immediate Postoperative Radiographs Change Patient Management After Fracture Fixation? A Systematic Review

Teo, Tammie; Schaeffer, Emily K.; Cooper, Anthony; Mulpuri, Kishore

doi:10.1097/bot.0000000000001152

Cited by 14 publications

(19 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Apparently, for other indications than extremity fractures, radiographs are also obtained routinely and without great impact on treatment strategies. In addition, for direct post-operative check radiographs of, for instance, hip fractures, multiple retrospective studies exist that debate their usefulness or discourage their use [ 32 – 35 ]. A randomized study investigating the usefulness of direct post-operative control radiographs for operatively treated wrist and ankle fractures is currently being conducted by Oehme et al [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

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

Gerven

Rubinstein²,

Nederpelt

et al. 2018

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Gerven

Rubinstein²,

Nederpelt

et al. 2018

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

show abstract

“…A 2018 systematic review found that immediate postoperative imaging led to an absolute benefit increase in identifying complications of only 0.22%. 15 This can be a valuable application in the current situation, and all imaging that will not change management should be avoided. With open fracture cases, consideration should be given to wash-out and application of a windowed cast.…”

Section: General Trauma Management Considerationsmentioning

confidence: 99%

Recommendations for the Care of Pediatric Orthopaedic Patients During the COVID-19 Pandemic

Farrell

Schaeffer

Mulpuri

2020

J Am Acad Orthop Surg

Self Cite

View full text Add to dashboard Cite

The COVID-19 pandemic has necessitated modifications to pediatric orthopaedic practice to protect patients, families, and healthcare workers and to minimize viral transmission. It is critical to balance the benefits of alterations to current practice to reduce the chances of COVID-19 infection, with the potential long-term impact on patients. Early experiences of the pandemic from orthopaedic surgeons in China, Singapore, and Italy have provided the opportunity to take proactive and preventive measures to protect all involved in pediatric orthopaedic care. These guidelines, based on expert opinion and best available evidence, provide a framework for the management of pediatric orthopaedic patients during the COVID-19 pandemic. General principles include limiting procedures to urgent cases such as traumatic injuries and deferring outpatient visits during the acute phase of the pandemic. Nonsurgical methods should be considered where possible. For patients with developmental or chronic orthopaedic conditions, it may be possible to delay treatment for 2 to 4 months without substantial detrimental long-term impact.

show abstract

“…A systematic review of articles, conducted by Teo et al . in 2018, described a number needed to treat of 453 patients needing post‐operative X‐rays in order to identify a complication, and a number needed to treat of 753 to identify a complication requiring a change in management 11 . Overall, the authors of this study did not support the use of routine post‐operative radiography following the use of IF 11 .…”

Section: Discussionmentioning

confidence: 89%

“…in 2018, described a number needed to treat of 453 patients needing post‐operative X‐rays in order to identify a complication, and a number needed to treat of 753 to identify a complication requiring a change in management 11 . Overall, the authors of this study did not support the use of routine post‐operative radiography following the use of IF 11 . Our relatively lower X‐rays required to identify a complication of 94 is likely explained by the relatively higher rate of complications identified in our study compared to this systematic review.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative fluoroscopy alone versus routine post‐operative X‐rays in identifying return to theatre after fracture fixation

Nair

Nambiar

Pope

et al. 2021

ANZ Journal of Surgery

View full text Add to dashboard Cite

Background Post‐operative imaging aims to assess fracture reduction and fixation with better resolution than intraoperative fluoroscopy (IF). However, this routine practice may increase costs and delay the discharge of patients. The aim of this study is to assess the role of post‐operative imaging in identifying patients that require a return to theatre following the use of IF. Methods A retrospective cohort study was conducted in a single health network comprising of two hospitals over 1 year. All fracture fixations that required IF were included. Patients who had post‐operative imaging were identified and complications requiring a return to theatre were obtained. Non‐trauma patients and those who did not have IF were excluded. Results A total of 1319 patients had IF. Of these patients, 1131 patients had post‐operative radiographs within 7 days of their operation. In total, 12 patients (1.1%) returned to theatre as a result of a finding identified in their post‐operative imaging. The calculated number of X‐rays required to be taken to identify a complication was 94. The main reasons identified for these cases to require a return to theatre despite having had IF included: (i) insufficient quality/views of IF, (ii) loss of position/new injury occurring in post‐operative period and (iii) poor reduction/fixation demonstrated intraoperatively that was missed/accepted. Conclusion The use of post‐operative radiographs can identify significant complications despite the use of IF in trauma patients. However, further consideration needs to be made regarding the benefits and costs of this practice in evaluating its clinical effectiveness.

show abstract

Do Immediate Postoperative Radiographs Change Patient Management After Fracture Fixation? A Systematic Review

Abstract: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 14 publications

References 15 publications

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

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

Recommendations for the Care of Pediatric Orthopaedic Patients During the COVID-19 Pandemic

Intraoperative fluoroscopy alone versus routine post‐operative X‐rays in identifying return to theatre after fracture fixation

Contact Info

Product

Resources

About