Effect of Initial Postoperative Visit Radiographs on Treatment Plans

Ghattas, Timothy N.; Dart, Bradley; Pollock, Anthony G.; Hinkin, Steven; Pham, Anh; Jones, Teresa L.Z.

doi:10.2106/jbjs.k.01670

Cited by 53 publications

(53 citation statements)

References 10 publications

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“…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%

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: Introductionmentioning

confidence: 99%

The role of outpatient visit after operative treatment of ankle fractures

Ovaska

Nuutinen

Madanat

et al. 2016

Injury

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“…The strong positive correlation we found suggests that computerized image analysis of plain radiographs may be considered as an adjunct to or a replacement for CT scanning in preclinical and clinical investigations of fracture healing, especially when study cost and radiographic exposure are limiting factors. The measurement of 2D callus area may also be particularly useful for retrospective studies in which only plain films are available for a patient group, as plain radiographs are the standard imaging modality used for post‐operative clinical visits . We can further evaluate our correlation results by using the slope and y ‐intercept determined from linear regression of the experimental data (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…The measurement of 2D callus area may also be particularly useful for retrospective studies in which only plain films are available for a patient group, as plain radiographs are the standard imaging modality used for post-operative clinical visits. 5 We can further evaluate our correlation results by using the slope and y-intercept determined from linear regression of the experimental data (Fig. 8C) to predict 3D callus volume from the 2D area measured by OrthoRead.…”

Section: Discussionmentioning

confidence: 99%

“…A barrier to addressing this challenge is the absence of universally recognized guidelines to evaluate fracture union from plain radiographs or X‐rays. While the acquisition and evaluation of X‐rays during post‐operative clinical visits is a standard in fracture care, there is no standard for radiographic assessment . The absence of standard assessment techniques is reflected by the 20–25% inter‐observer variability reported by clinicians analyzing radiographs for fracture healing .…”

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confidence: 99%

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Automated measurement of fracture callus in radiographs using portable software

Porter

Dailey

Hollar

et al. 2016

Journal Orthopaedic Research

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The development of software applications that assist the radiographic evaluation of fracture healing could advance clinical diagnosis and expedite the identification of effective treatment strategies. A radiographic feature regularly used as an outcome measure for basic and clinical fracture healing research is new bone growth, or fracture callus. In this study, we developed OrthoRead, a portable software application that uses image-processing algorithms to detect and measure fracture callus in plain radiographs. OrthoRead utilizes an optimal boundary tracking algorithm to semi-automatically segment the cortical surface, and a novel iterative thresholding selection algorithm to then automatically segment the fracture callus. The software was validated in three steps. First, algorithm accuracy and sensitivity were analyzed using surrogate models with known callus size. Second, the callus area of distal femur fractures measured using OrthoRead was compared to callus area manually outlined by orthopaedic surgeons. Third, the callus area of ovine tibial fractures was measured using OrthoRead and compared to callus volume measured from micro-CT. The software had less than a 5% error in measuring surrogate callus, and was insensitive to changes in image resolution, image rotation, and the size of the analyzed region of interest. Strong positive correlations existed between OrthoRead and clinicians (R2 = 0.98), and between 2D callus area and 3D callus volume (R2 = 0.70). The average run time for OrthoRead was 3 s when using a 2.7 GHz processor. By being accurate, fast, and robust, OrthoRead can support prospective and retrospective clinical studies investigating implant efficacy, and can assist research on fracture healing mechanobiology.

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“…Data included any changes in normal postoperative management, which was defined as any procedure or surgical intervention that is not typically undertaken after the first postoperative visit. 4 This did not include any planned, staged fracture fixation or planned removal of hardware. Lastly, the time to final follow-up was also recorded.…”

Section: Methodsmentioning

confidence: 99%