Utility and Cost Analysis of Radiographs Taken 2 Weeks Following Plate Fixation of Distal Radius Fractures

Stone, Jeffrey D.; Vaccaro, L; Brabender, Robert C.; Hess, Alfred V.

doi:10.1016/j.jhsa.2015.02.013

Cited by 37 publications

(24 citation statements)

References 12 publications

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“…Furthermore, Huffaker et al [ 15 ] demonstrated for operatively treated AO/OTA-type 23A fractures that 94% of the radiographs that were obtained post-operatively did not influence clinical decision making. Stone et al [ 11 ] showed a change in treatment strategy in only three (1%) patients on the 2-week post-op radiograph. These three patients all had suffered a new trauma and would been identified clinically if radiographs were not standard at the first post-operative visit.…”

Section: Discussionmentioning

confidence: 99%

Routine follow-up radiographs for distal radius fractures are seldom clinically substantiated

Weil

Moumni

Rubinstein

et al. 2017

Arch Orthop Trauma Surg

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IntroductionThe value of routine radiographs during follow-up after distal radius fractures is unclear. The aim of this study was to evaluate whether routine radiographs performed during the follow-up period in patients with a distal radius fracture influenced clinical decision making.MethodsThis retrospective cohort study included patients aged ≥18 years who were treated for a distal radius fracture at four hospitals in The Netherlands in 2012. Demographic and clinical and radiographic characteristics were collected from medical records.Results1042 patients were included. In 121 (14%) of the 841 radiographs, a clinical indication was reported. Treatment was affected by 22 (2.6%) radiographs, including 11 (1.5%) radiographs that were categorized as routine, 9 (1.2%) of which led to prolonged cast immobilization and 2 (0.2%) to surgery for conservatively treated patients.ConclusionAlthough it is common practice to take radiographs after distal radius fractures, the study results indicate that routine radiographs seldom affect treatment. This finding should be weighed against the high health care costs associated with these fractures. We hope that the results of our study will trigger the awareness among surgeons that in the current practice, many radiographs are taken on routine without influencing clinical decision making and can probably be omitted.Level of evidenceLevel III.

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Section: Discussionmentioning

confidence: 99%

Routine follow-up radiographs for distal radius fractures are seldom clinically substantiated

Weil

Moumni

Rubinstein

et al. 2017

Arch Orthop Trauma Surg

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“…The authors concluded that routinely imaging fractures at this time point may add unnecessary cost. 12 Alternative paradigms have been explored for the use of plain X-rays in conditions with low radiographic diagnostic yield. A 1986 study applied specific indications for obtaining lumbar X-rays in low back pain, and found that the yield of imaging using these specific criteria increased three times over routine films in all patients, without causing higher rates of underdiagnosis.…”

Section: Discussionmentioning

confidence: 99%

Are Plain X-Rays Necessary in the Diagnosis of De Quervain's Tenosynovitis?

et al. 2020

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Background The routine use of plain radiography represents a significant expenditure and has been proven unnecessary in several orthopedic conditions. The utility of plain radiographs in the diagnosis of De Quervain's tenosynovitis (DeQ) is not clear. Questions/Purpose This study evaluates whether plain radiographic findings routinely predict the need for surgery or alter treatment courses in the initial diagnosis of DeQ. Patients and Methods A total of 200 patients who received wrist X-rays and had a diagnosis of DeQ were retrospectively selected at random. Their images were evaluated for relevant findings, including radial styloid abnormalities, arthritis, and tendon calcification. A chart review was performed to determine whether these X-rays altered the treatment courses. Results Of the 200 patients, 141 (69.1%) cases had at least one positive radiographic finding. Carpometacarpal joint (CMC) arthritis was the most common finding, seen in 63 (30.9%) cases. Of all patients, 141 (69.1%) were treated with corticosteroid injection only, 54 (26.5%) with corticosteroid injection and ultimately surgery, and 9 (4.4%) with surgery alone. There were no significant differences in the rates of surgery with positive X-ray findings. There were no cases in which radiographic findings resulted in a change in management, per the report of the treating physician. Conclusions Despite the high proportion of positive findings on X-ray, no radiographic findings altered the course of treatment in patients with isolated DeQ. Obtaining plain radiographs for isolated DeQ represents a significant cost and should be reserved for cases in which the results are preemptively deemed likely to influence the treatment course. Level of Evidence This is a level IV study.

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“…Ghattas et al [9] noted that after fixation of an acute fracture, the majority of radiographs taken during the first post-operative visit do not alter the patient's treatment plan; they just lead to extra costs for the patient and the health care system [9]. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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]. Thus, although the benefit of early postoperative radiographs remains questionable, they do increase costs for the patient and health care system.…”

Section: Introductionmentioning

confidence: 99%

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

Kuorikoski

Söderlund

2017

Injury

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Utility and Cost Analysis of Radiographs Taken 2 Weeks Following Plate Fixation of Distal Radius Fractures

Cited by 37 publications

References 12 publications

Routine follow-up radiographs for distal radius fractures are seldom clinically substantiated

Routine follow-up radiographs for distal radius fractures are seldom clinically substantiated

Are Plain X-Rays Necessary in the Diagnosis of De Quervain's Tenosynovitis?

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

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