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

Abstract

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.

Five historical innovations that have shaped modern orthopaedic surgery

“…The mobile X-ray machine used in theatre is known as a C-arm, due to the C-shape of the X-ray tube and image intensifier (Toppenberg et al 2020). There are many benefits to the use of intraoperative fluoroscopy, namely, accurate fracture reduction and alignment, which is key in the management of both simple and comminuted fractures as poor reduction and alignment increases the risk of malunion resulting in early arthritis, reduced functionality and decreased quality of life (Nair et al 2021).…”

Optimisation of postoperative X-ray acquisition for orthopaedic patients

“…Nair et al 10 examined 1319 patients in his institution who had undergone surgery involving intra-operative fluoroscopy of which 1131 had postoperative X-rays performed within the first week. Twelve patients were identified to have significant complications discovered on postoperative X-rays which required return to theatre.…”

Efficacy of Postoperative Radiographs After Intramedullary Nailing of the Tibia and Femur: When Are They Useful?

“…1 , 2 The goal of this surveillance is to monitor for appropriate healing and assess for complications, including those requiring revision surgery. 3 Among complications, nonunion is of particular note because of patient morbidity and the notable cost of intervention. 4 , 5 , 6 As such, history, physical examination, and regular postoperative surveillance radiographs are common and central facets of fracture care to monitor for postfixation complications.…”