Skip to main content
Top
Published in: European Journal of Trauma and Emergency Surgery 6/2019

01-12-2019 | Original Article

Is there a need for standardized postoperative radiographs after operative treatment of wrist or ankle fractures?

Authors: Florian Oehme, Björn Christian Link, Herman Frima, Tim Schepers, Steven J. Rhemrev, Reto Babst, Frank J. P. Beeres

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2019

Login to get access

Abstract

Purpose

The purpose of this study was to evaluate the frequency of changes in treatment plan due to standardized postoperative radiographs. A secondary aim was to compare our results with a national benchmark.

Methods

This is a single-center retrospective case series of 167 consecutive patients, operated with open reduction and internal fixation (ORIF) for distal radius or ankle fractures in 2014. Changes in the treatment protocol were defined as additional CT-imaging, reoperation or other changes as stated in the postoperative instructions. In addition, a national survey was conducted assessing differences between surgeons in different hospitals concerning revision rates.

Results

In 7.2% (12/167) of the patients, a change in the treatment plan was recorded after the standardized postoperative radiographs. 10 patients (6%) were reoperated (three without additional imaging, seven after additional imaging with CT). The results from our survey showed a good assessment concerning the quality of intraoperative imaging (7.85 on a scale from 0 to 10). Concerning the revision rate, there was a trend to lower revision rate of 8.1% in the six observers.

Conclusions

Standard postoperative radiographs could improve quality of care. Intraoperative standardized radiographic documentation is needed and the perception and acceptance of quality may vary between hospitals.
Literature
1.
go back to reference Bott OJ, Dresing K, Wagner M, Raab BW, Teistler M. Informatics in radiology: use of a C-arm fluoroscopy simulator to support training in intraoperative radiography. Radiographics. 2011;31:E65–75.CrossRef Bott OJ, Dresing K, Wagner M, Raab BW, Teistler M. Informatics in radiology: use of a C-arm fluoroscopy simulator to support training in intraoperative radiography. Radiographics. 2011;31:E65–75.CrossRef
2.
go back to reference Blattert TR, Fill UA, Kunz E, Panzer W, Weckbach A, Regulla DF. Skill dependence of radiation exposure for the orthopaedic surgeon during interlocking nailing of long-bone shaft fractures: a clinical study. Arch Orthop Trauma Surg Archiv fur orthopadische und Unfall-Chirurgie. 2004;124:659–64.CrossRef Blattert TR, Fill UA, Kunz E, Panzer W, Weckbach A, Regulla DF. Skill dependence of radiation exposure for the orthopaedic surgeon during interlocking nailing of long-bone shaft fractures: a clinical study. Arch Orthop Trauma Surg Archiv fur orthopadische und Unfall-Chirurgie. 2004;124:659–64.CrossRef
3.
go back to reference Haddad FS, Williams RL, Prendergast CM. The check X-ray: an unnecessary investigation after hip fracture fixation? Injury. 1996;27:351–2.CrossRef Haddad FS, Williams RL, Prendergast CM. The check X-ray: an unnecessary investigation after hip fracture fixation? Injury. 1996;27:351–2.CrossRef
4.
go back to reference Harish S, Vince AS, Patel AD. Routine radiography following ankle fracture fixation: a case for limiting its use. Injury. 1999;30:699–701.CrossRef Harish S, Vince AS, Patel AD. Routine radiography following ankle fracture fixation: a case for limiting its use. Injury. 1999;30:699–701.CrossRef
5.
go back to reference Pattison RM, Calzada S, Koka SR, James SE. Postoperative radiographs or thermal prints after internal fixation of fractures? A study of DHS fixation of hip fractures. Ann R Coll Surg Engl. 1996;78:509–11.PubMedPubMedCentral Pattison RM, Calzada S, Koka SR, James SE. Postoperative radiographs or thermal prints after internal fixation of fractures? A study of DHS fixation of hip fractures. Ann R Coll Surg Engl. 1996;78:509–11.PubMedPubMedCentral
6.
go back to reference Chakravarthy J, Mangat K, Qureshi A, Porter K. Postoperative radiographs following hip fracture surgery. Do they influence patient management? Int J Clin Pract. 2007;61:421–4.CrossRef Chakravarthy J, Mangat K, Qureshi A, Porter K. Postoperative radiographs following hip fracture surgery. Do they influence patient management? Int J Clin Pract. 2007;61:421–4.CrossRef
7.
go back to reference Tufescu T. The cost of screening radiographs after stable fracture fixation. Can J Surg J Canadien de Chirurgie. 2017;60:53–6. Tufescu T. The cost of screening radiographs after stable fracture fixation. Can J Surg J Canadien de Chirurgie. 2017;60:53–6.
8.
go back to reference Stone JD, Vaccaro LM, Brabender RC, Hess AV. Utility and cost analysis of radiographs taken 2 weeks following plate fixation of distal radius fractures. J Hand Surg. 2015;40:1106–9.CrossRef Stone JD, Vaccaro LM, Brabender RC, Hess AV. Utility and cost analysis of radiographs taken 2 weeks following plate fixation of distal radius fractures. J Hand Surg. 2015;40:1106–9.CrossRef
9.
go back to reference Seeley DG, Kelsey J, Jergas M, Nevitt MC. Predictors of ankle and foot fractures in older women. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res. 1996;11:1347–55.CrossRef Seeley DG, Kelsey J, Jergas M, Nevitt MC. Predictors of ankle and foot fractures in older women. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res. 1996;11:1347–55.CrossRef
10.
go back to reference Spaine LA, Bollen SR. ‘The bigger they come … the relationship between body mass index and severity of ankle fractures. Injury. 1996;27:687–9.CrossRef Spaine LA, Bollen SR. ‘The bigger they come … the relationship between body mass index and severity of ankle fractures. Injury. 1996;27:687–9.CrossRef
11.
go back to reference Tinubu J, Scalea TM. Management of fractures in a geriatric surgical patient. Surg Clin N Am. 2015;95:115–28.CrossRef Tinubu J, Scalea TM. Management of fractures in a geriatric surgical patient. Surg Clin N Am. 2015;95:115–28.CrossRef
12.
go back to reference Tufescu T. Working toward reducing postoperative fracture radiographs: a survey of Canadian surgeons. Can J Surg J Canadien de Chirurgie. 2016;59:26–8.CrossRef Tufescu T. Working toward reducing postoperative fracture radiographs: a survey of Canadian surgeons. Can J Surg J Canadien de Chirurgie. 2016;59:26–8.CrossRef
13.
go back to reference von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–9.CrossRef von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–9.CrossRef
14.
go back to reference Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Jt Surg Am Vol. 1976;58:453–8.CrossRef Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Jt Surg Am Vol. 1976;58:453–8.CrossRef
15.
go back to reference Tarallo L, Mugnai R, Zambianchi F, Adani R, Catani F. Volar plate fixation for the treatment of distal radius fractures: analysis of adverse events. J Orthop Trauma. 2013;27:740–5.CrossRef Tarallo L, Mugnai R, Zambianchi F, Adani R, Catani F. Volar plate fixation for the treatment of distal radius fractures: analysis of adverse events. J Orthop Trauma. 2013;27:740–5.CrossRef
16.
go back to reference Stockle U, Konig B, Dahne M, Raschke M, Haas NP. Computer assisted pelvic and acetabular surgery. Clinical experiences indications. Unfallchirurg. 2002;105:886–92.CrossRef Stockle U, Konig B, Dahne M, Raschke M, Haas NP. Computer assisted pelvic and acetabular surgery. Clinical experiences indications. Unfallchirurg. 2002;105:886–92.CrossRef
17.
go back to reference Atesok K, Finkelstein J, Khoury A, et al. The use of intraoperative three-dimensional imaging (ISO-C-3D) in fixation of intraarticular fractures. Injury. 2007;38:1163–9.CrossRef Atesok K, Finkelstein J, Khoury A, et al. The use of intraoperative three-dimensional imaging (ISO-C-3D) in fixation of intraarticular fractures. Injury. 2007;38:1163–9.CrossRef
18.
go back to reference Carelsen B, Haverlag R, Ubbink DT, Luitse JS, Goslings JC. Does intraoperative fluoroscopic 3D imaging provide extra information for fracture surgery? Arch Orthop Traum Surg Archiv fur Orthopadische und Unfall-Chirurgie. 2008; 128: 1419–24.CrossRef Carelsen B, Haverlag R, Ubbink DT, Luitse JS, Goslings JC. Does intraoperative fluoroscopic 3D imaging provide extra information for fracture surgery? Arch Orthop Traum Surg Archiv fur Orthopadische und Unfall-Chirurgie. 2008; 128: 1419–24.CrossRef
19.
go back to reference Geerling J, Kendoff D, Citak M, et al. Intraoperative 3D imaging in calcaneal fracture care-clinical implications and decision making. J Trauma. 2009;66:768–73.CrossRef Geerling J, Kendoff D, Citak M, et al. Intraoperative 3D imaging in calcaneal fracture care-clinical implications and decision making. J Trauma. 2009;66:768–73.CrossRef
20.
go back to reference Ruan Z, Luo CF, Zeng BF, Zhang CQ. Percutaneous screw fixation for the acetabular fracture with quadrilateral plate involved by three-dimensional fluoroscopy navigation: surgical technique. Injury. 2012;43:517–21.CrossRef Ruan Z, Luo CF, Zeng BF, Zhang CQ. Percutaneous screw fixation for the acetabular fracture with quadrilateral plate involved by three-dimensional fluoroscopy navigation: surgical technique. Injury. 2012;43:517–21.CrossRef
21.
go back to reference Edwards CC 2nd, Haraszti CJ, McGillivary GR, Gutow AP. Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction. J Hand Surg. 2001;26:1036–41.CrossRef Edwards CC 2nd, Haraszti CJ, McGillivary GR, Gutow AP. Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction. J Hand Surg. 2001;26:1036–41.CrossRef
22.
go back to reference Ruch DS, Vallee J, Poehling GG, Smith BP, Kuzma GR. Arthroscopic reduction versus fluoroscopic reduction in the management of intra-articular distal radius fractures. Arthroscopy. 2004;20:225–30.CrossRef Ruch DS, Vallee J, Poehling GG, Smith BP, Kuzma GR. Arthroscopic reduction versus fluoroscopic reduction in the management of intra-articular distal radius fractures. Arthroscopy. 2004;20:225–30.CrossRef
Metadata
Title
Is there a need for standardized postoperative radiographs after operative treatment of wrist or ankle fractures?
Authors
Florian Oehme
Björn Christian Link
Herman Frima
Tim Schepers
Steven J. Rhemrev
Reto Babst
Frank J. P. Beeres
Publication date
01-12-2019
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 6/2019
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-018-0977-9

Other articles of this Issue 6/2019

European Journal of Trauma and Emergency Surgery 6/2019 Go to the issue