The role of outpatient visit after operative treatment of ankle fractures

Ovaska, Mikko; Nuutinen, Timo; Madanat, Rami; Mäkinen, Tuula; Söderlund, Tim

doi:10.1016/j.injury.2016.09.008

Cited by 21 publications

(26 citation statements)

References 18 publications

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“…None of the studies fulfilled the criteria for comparability, given that none controlled for baseline factors. Six studies (i.e., McDonald et al [ 19 ], Ovaska et al [ 20 ], Kempegowda et al [ 21 ], Weil et al [ 23 ], Stone et al [ 24 ], and Huffaker et al [ 25 ]) scored the maximum number of three points for the outcome domain. All other studies scored two points, mainly because no statement was made on the adequacy of follow-up.…”

Section: Resultsmentioning

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

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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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Section: Resultsmentioning

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

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“…According to Stone et al [12], routine two-week post-operative radiographs for wrist fracture patients rarely result in changes in patient management [12]. Ovaska et al [11] recently studied the role of an outpatient visit after an ankle fracture surgery. The results suggested that routine radiographs would not be necessary at an early outpatient visit after ankle fracture surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The results suggested that routine radiographs would not be necessary at an early outpatient visit after ankle fracture surgery. However, 9.8% of 878 patients required a change in treatment plan post-operatively and only 37% of these patients had solicited earlier outpatient visit prior to scheduled follow-up visit, therefore it seems reasonable to continue these outpatient visits, since 6.2% of patients had a change in the treatment plan at the scheduled follow-up visit [11].…”

Section: Discussionmentioning

confidence: 99%

“…Some evidence indicates that early radiographs after ankle fracture fixation do not lower the complication rate and could be omitted [10]. In only three of 878 ankle fracture patients (0.3%), the treatment plan was changed in the first followup visit due to radiological findings [11]. Stone et al [12] demonstrated that post-operative radiographs taken two weeks following plate fixation of distal radial fractures rarely resulted in changes in patient management, but added an extra cost to the health care system [12].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a routine follow-up visit after an internal fixation of proximal femoral fracture

Kuorikoski

Söderlund

2017

Injury

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“…Various studies have questioned the value of routine radiographs obtained at the first outpatient clinic visit and at intermediate-to-late follow-up (i.e. after the initial 3 weeks) of operatively treated ankle fractures [ 18 , 19 ]. A recent retrospective analysis, involving a cohort of 528 patients with an ankle fracture, demonstrated that as few as 1.2% ( n = 11/928) of routine radiographs obtained after 3 weeks of follow-up led to a change in treatment strategy [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Reduction of routine use of radiography in patients with ankle fractures leads to lower costs and has no impact on clinical outcome: an economic evaluation

Gerven

Dongen

Rubinstein

et al. 2020

BMC Health Serv Res

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Background To evaluate the cost-effectiveness of a reduction in the number of routine radiographs in the follow-up of patients with ankle fractures. Methods We performed an economic evaluation alongside the multicentre, randomised WARRIOR trial. Participants were randomised to a reduced imaging follow-up protocol (i.e. radiographs at week 6 and 12 follow-up obtained on clinical indication) or usual care (i.e. routine radiography at weeks 6 and 12). The Olerud & Molander Ankle Score (OMAS) was used to assess ankle function and the EQ-5D-3L was used to estimate Quality-Adjusted Life Years (QALYs). Costs and resource use were assessed using self-reported questionnaires and medical records, and analysed from a societal perspective. Multiple imputation was used for missing data, and data were analysed using seemingly unrelated regression analysis and bootstrapping. Results In total, 246 patients had data available for analysis (reduced imaging = 118; usual care = 128). Fewer radiographs were obtained in the reduced imaging group (median = 4) compared with the usual-care group (median = 5). Functional outcome was comparable in both groups. The difference in QALYs was − 0.008 (95% CI:-0.06 to 0.04) and the difference in OMAS was 0.73 (95% CI:-5.29 to 6.76). Imaging costs were lower in the reduced imaging group (−€48; 95% CI:- €72 to -€25). All other cost categories did not statistically differ between the groups. The probability of the reduced imaging protocol being cost-effectiveness was 0.45 at a wiliness-to-pay of €20,000 per QALY. Conclusions Reducing the number of routine follow-up radiographs has a low probability of being cost-effective compared with usual care. Functional outcome, health-related quality of life and societal costs were comparable in both groups, whereas imaging costs were marginally lower in the reduced imaging group. Given this, adherence to a reduced imaging follow-up protocol for those with routine ankle fractures can be followed without sacrificing quality of care, and may result in reduced costs. Trial registration The trial was registered on 26-05-2014 in the Netherlands Trial Registry, with reference number NL4477 (www.trialregister.nl/trial/4477).

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The role of outpatient visit after operative treatment of ankle fractures

Cited by 21 publications

References 18 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

Evaluation of a routine follow-up visit after an internal fixation of proximal femoral fracture

Reduction of routine use of radiography in patients with ankle fractures leads to lower costs and has no impact on clinical outcome: an economic evaluation

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