gms | German Medical Science

Objectives: Distal radius and ankle fractures are one of the most common operatively treated fractures. To date, there is no consensus concerning the need for a standard postoperative radiograph. This leads to undesirable practice variations. If standardized intraoperative radiographs have been obtained, it is questionable if these postoperative radiographs are necessary and will lead to changes in the treatment strategy. If standard postoperative radiographs are no longer required, this would lead to a reduction in radiation exposure and health care costs. The hypothesis is that routine standardized postoperative radiographs do not influence the quality of care for patients operated on for either a distal radius or an ankle fracture if adequate intraoperative standardized radiographs have been obtained.

The primary aim of this study is to evaluate if there is a need for routine postoperative radiographs after an osteosynthesis of a distal radius or ankle fracture.

Methods: In a prospective, randomized controlled, open label trial based on a non-inferiority design, we enrolled 332 patients. The control group was treated according to our current, standard protocol in which all patients received a standard anterior-posterior and lateral radiograph on the first postoperative day. Patients randomized to the intervention group were treated without a standard postoperative radiograph. All patients (n=332) had a routine clinical and radiographic control after 6 weeks in the outpatient clinic. Primary outcome is a change in treatment plan, defined as either additional imaging or a reoperation based on the intraoperative or postoperative imaging.

Results and conclusion: The trial started in August 2016 and ended in September 2018. 445 patients were screened, 332 were included. In the control group 4 out of 155 (2.6%) had an additional imaging or e reoperation, in the intervention group 8 out of 164 (4.9%) had a change in treatment plan. Statistically there is a non inferiority of the intraoperative radiographs compared to the additional postoperative radiographs.

Our findings prove that there is no need of postoperative radiographs if the intraoperative radio-graphs are adequate. This may lead to a strong reduction in radiation exposure and health care costs.