No additional value of routine check X-rays after internal fixation of hip fractures

Westerterp, Marinke; Emous, Marloes; Vermeulen, M. C.; Eerenberg, J. P.; Geloven, A. A. W. van

doi:10.1007/s00068-012-0244-4

Cited by 9 publications

(10 citation statements)

References 5 publications

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“…The same was shown for MRI or CT in pelvic ring fracture [ 91 , 135 – 137 ]. In hip fracture and hemiarthroplasty, routine post-op X-ray of the hip was low-value for patients without symptoms [ 138 , 139 ]. One study showed that MRI is low-value in patients with hip pain when an X-ray is already acquired [ 140 ].…”

Section: Resultsmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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Background Inappropriate and wasteful use of health care resources is a common problem, constituting 10–34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging—in which the diagnostic test confers little to no clinical benefit—is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. Methods A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. Results A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. Conclusions A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. Systematic review registration: PROSPERO: CRD42020208072.

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Section: Resultsmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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“…In particular, there were four adult shoulder injuries that required a return to theatre following post‐operative imaging. This is a region which has been poorly described in terms of patients requiring return to theatre, as most of the studies have focused on the distal radius and scaphoid, 9,12–14 ankle 5 and hip fractures 7,15,16 . Of the four patients who had shoulder operations returning to theatre in our study, one suffered a new fracture, one sustained a loss of fixation of an acromioclavicular joint stabilization, while two patients had failure of fixation of a greater tuberosity fragment.…”

Section: Discussionmentioning

confidence: 93%

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

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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.

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“…Most studies were based on case series ( n = 33) 22,31,33,34,36,38,41,43‐50,56,57,60‐64,66,68‐72,74,75,77,85,89,90 followed by systematic reviews with or without meta‐analysis ( n = 12), 23‐25,28,29,39,53,59,67,78,83,86,88,91 prospective cohorts ( n = 9), 30,32,35,37,42,51,54,79,87 RCTs ( n = 9) 27,55,65,73,80‐82,84 and retrospective cohorts ( n = 2; Supplemental Digital File ) 52,58 …”

Section: Resultsmentioning

confidence: 99%

Low‐value injury care in the adult orthopaedic trauma population: A systematic review

Bérubé

Moore

Tardif

et al. 2021

Int J Clinical Practice

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Objectives Fifteen potentially low value practices in adult orthopaedic trauma care were previously identified in a scoping review. The aim of this study was to synthesise the evidence on these practices. Methods We searched four databases for systematic reviews, randomised controlled trials (RCTs), cohort studies and case series that assessed the effectiveness of selected practices. Methodological quality was evaluated using the Measurement Tool to Assess Systematic Reviews version 2 (AMSTAR‐2) for systematic reviews and the Critical Appraisal Checklist for Case Series. We evaluated risk of bias with the Cochrane revised tool for RCTs and the risk of bias in non‐randomised studies of interventions tool for observational studies. We summarised findings with measures of frequency and association for primary outcomes. Results Of the 30,670 records screened, 70 studies were retained. We identified high‐level evidence of lack of effectiveness or harm for routine initial imaging of ankle injury, orthosis for A0‐A3 thoracolumbar burst fracture in patients <60 years of age, cast or splint immobilisation for suspected scaphoid fracture negative on MRI or confirmed fifth metacarpal neck fracture, and routine follow‐up imaging for distal radius and ankles fractures. However, evidence was mostly based on studies of low methodological quality or high risk of bias. Conclusion In this review, we identified clinical practices in orthopaedic injury care which are not supported by current evidence and whose use may be questioned. In future research, we should measure their frequency, assess practice variations and evaluate root causes to identify practices that could be targeted for de‐implementation.

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No additional value of routine check X-rays after internal fixation of hip fractures

Abstract: A check X-ray following internal fixation of hip fractures after adequate peroperative image intensifier guidance is not useful. Dismissing this unuseful medical investigation, leads to less radiation exposure, less pain and less costs.

Cited by 9 publications

References 5 publications

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

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

Low‐value injury care in the adult orthopaedic trauma population: A systematic review

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