Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2018 | Research article

Routine early post-operative X-ray following internal fixation of intertrochanteric femoral fractures is unjustified: a quality improvement study

Authors: David Segal, Ezequiel Palmanovich, Ali Faour, Elad Marom, Viktor Feldman, Eyal Yaacobi, Omer Slevin, Benjamin Kish, Yaron S. Brin

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2018

Abstract

Background

There is no consensus regarding the proper radiographic protocol following closed or open reduction and internal fixation for intertrochanteric femoral fractures. The objective of this study was to assess the role of early postoperative imaging studies when deciding about weight bear limitations and reoperations.

Methods

A prospective cohort study of 100 patients (26 men and 74 women, at a mean age of 79.8 years) treated by closed or open reduction and internal fixation for AO31A fractures was conducted. According to the AO classification, there were 25 cases of 31A1, 54 cases of 31A2, and 21 cases of 31A3. For every patient, the intraoperative fluoroscopy studies were recorded and post-operative radiograms were taken during the first week. Excluded were patients for whom the early X-rays were clinically indicated. The intraoperative AP and axial fluoroscopy studies were compared with the radiograms taken during the first post-operative week. The investigators compared the decisions regarding weight-bearing limitations and the need for re-operation before and after conducting the radiograms.

Results

The early post-operative imaging studies did not change weight-bearing limitations nor did they lead to consecutive surgical treatments.

Conclusions

Unless indicated by physical examination, there is no value to routine post-operative radiograms within the first few days after closed reduction and internal fixation of intertrochanteric femoral fractures with regard to weight-bearing limitations and re-operation decisions.

Trial registration

Identifier: NCT02868125.

Gehlbach SH, Avrunin JS, Puleo E. Trends in hospital care for hip fractures. Osteoporos Int. 2007;18:585–91.CrossRefPubMed

Bhandari M, Devereaux PJ, Tornetta P, Swiontkowski MF, Berry DJ, Haidukewych G, et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am. 2005;87:2122–30.CrossRefPubMed

Tufescu T. Working toward reducing postoperative fracture radiographs: a survey of Canadian surgeons. Can J Surg. 2016;59:26–8.CrossRefPubMedPubMedCentral

Hsueh K-K, Fang C-K, Chen C-M, Su Y-P, Wu H-F, Chiu F-Y. Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients. Int Orthop. 2010;34:1273–6.CrossRefPubMed

Cooney AD, Campbell AC. Do check X-rays influence the management of patients who have undergone hip fracture fixation using image intensifier guidance? Injury. 2006;37:763–7.CrossRefPubMed

Mohanty K, Gupta SK, Evans RM. Check radiography after fixation of hip fractures: is it necessary? J R Coll Surg Edinb. 2000;45:398–9.PubMed

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.CrossRefPubMed

Haddad FS, Williams RL, Prendergast CM. The check X-ray: an unnecessary investigation after hip fracture fixation? Injury. 1996;27:351–2.CrossRefPubMed

Khurana A. Do check X-rays influence the management of patients who have undergone hip fracture fixation using image intensifier guidance? Injury. 2007.

10.

Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, et al. Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21:S1–133.CrossRefPubMed

11.

Cleveland M, Bosworth DM, Thompson FR, Wilson HJ, Ishizuka T. A ten-year analysis of intertrochanteric fractures of the femur. J. Bone Joint Surg. Am. 1959;41–A:1399–408.CrossRefPubMed

12.

Herman A, Landau Y, Gutman G, Ougortsin V, Chechick A, Shazar N. Radiological evaluation of intertrochanteric fracture fixation by the proximal femoral nail. Injury. 2012;43:856–63.CrossRefPubMed

13.

Güven M, Yavuz U, Kadıoğlu B, Akman B, Kılınçoğlu V, Ünay K, et al. Importance of screw position in intertrochanteric femoral fractures treated by dynamic hip screw. Rev Cir Ortop Traumatol. 2010;96:33–4.

14.

Lobo-Escolar A, Joven E, Iglesias D, Herrera A. Predictive factors for cutting-out in femoral intramedullary nailing. Injury. 2010;41:1312–6.CrossRefPubMed

15.

Turgut A, Kalenderer Ö, Karapınar L, Kumbaracı M, Akkan HA, Ağuş H. Which factor is most important for occurrence of cutout complications in patients treated with proximal femoral nail antirotation? Retrospective analysis of 298 patients. Arch. Orthop. Trauma Surg. Springer Berlin Heidelberg. 2016;136:623–30.CrossRefPubMed

16.

Flores SA, Woolridge A, Caroom C, Jenkins M. The utility of the tip–apex distance in predicting axial migration and cutout with the trochanteric fixation nail system helical blade. J Orthop Trauma. 2016;30:e207–11.CrossRefPubMed

17.

Liu W, Zhou D, Liu F, Weaver MJ, Vrahas MS. Mechanical complications of intertrochanteric hip fractures treated with trochanteric femoral nails. J Trauma Acute Care Surg. 2013;75:304–10.CrossRefPubMed

18.

Geller JA, Saifi C, Morrison TA, Macaulay W. Tip apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures. Int Orthop. 2010;34:719–22.CrossRefPubMed

19.

Nikoloski AN, Osbrough AL, Yates PJ. Should the tip apex distance (TAD) rule be modified for the proximal femoral nail antirotation (PFNA)? A retrospective study. J Orthop Surg Res. 2013;8:35.CrossRefPubMedPubMedCentral

20.

Mingo-Robinet J, Torres-Torres M, Martínez-Cervell C, Alonso Del Olmo JA, Rivas Laso JA, Aguado-Hernández H, et al. Comparative study of the second and third generation of gamma nail for trochanteric fractures: review of 218 cases. J Orthop Trauma. 2015;29:e85–90.CrossRefPubMed

21.

van Embden D, Stollenwerck GANL, Koster LA, Kaptein BL, Nelissen RGHH, Schipper IB. The stability of fixation of proximal femoral fractures: a radiostereometric analysis. Bone Joint J. British Editorial Society of Bone and Joint Surgery. 2015;97–B:391–7.CrossRefPubMed

22.

Gardner MJ, Briggs SM, Kopjar B, Helfet DL, Lorich DG. Radiographic outcomes of intertrochanteric hip fractures treated with the trochanteric fixation nail. Injury. 2007;38:1189–96.CrossRefPubMed

23.

Pajarinen J, Lindahl J, Savolainen V, Michelsson O, Hirvensalo E. Femoral shaft medialisation and neck-shaft angle in unstable pertrochanteric femoral fractures. Int Orthop. 2004;28:347–53.PubMedPubMedCentral

24.

Pannell WC, Alluri RK, Sivasundaram L, Heckmann N, Ghiassi A. Utility of postoperative imaging in radial shaft fractures. HAND. SAGE Publications; 2016;11:https://doi.org/10.1177/1558944715627629.

25.

Mettler FA, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology. 2008;248:254–63.CrossRefPubMed

26.

Chehade MJ, Carbone T, Awward D, Taylor A, Wildenauer C, Ramasamy B, et al. Influence of fracture stability on early patient mortality and reoperation after pertrochanteric and intertrochanteric hip fractures. J Orthop Trauma. 2015;29:538–43.CrossRefPubMed

27.

Aguado-Maestro I, Escudero-Marcos R, García-García JM, Alonso-García N, Pérez-Bermejo DD, Aguado-Hernández HJ, et al. Results and complications of pertrochanteric hip fractures using an intramedullary nail with a helical blade (proximal femoral nail antirotation) in 200 patients. Rev Esp Cir Ortop Traumatol. 2013;57(3):201–7.PubMed

Title: Routine early post-operative X-ray following internal fixation of intertrochanteric femoral fractures is unjustified: a quality improvement study
Authors: David Segal
Ezequiel Palmanovich
Ali Faour
Elad Marom
Viktor Feldman
Eyal Yaacobi
Omer Slevin
Benjamin Kish
Yaron S. Brin
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2018
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-018-0896-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Routine early post-operative X-ray following internal fixation of intertrochanteric femoral fractures is unjustified: a quality improvement study

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2018

Kinetic of bone turnover markers after osteoporotic vertebral compression fractures in postmenopausal female

Treatment of AC dislocation by reconstructing CC and AC ligaments with allogenic tendons compared with hook plates

Coatings as the useful drug delivery system for the prevention of implant-related infections

Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers

Using anatomical landmarks to calculate the normal joint line position in Chinese people: an observational study

Association of advanced glycation end products in Dupuytren disease