From the Carolinas Medical Center, Charlotte, NC (Dr. Phelps, Dr. Seymour, and Dr. Bosse), and Baylor College of Medicine, Houston, TX (Dr. Coleman).
J Am Acad Orthop Surg. 2018 Nov 15;26(22):799-808. doi: 10.5435/JAAOS-D-17-00114.
The goal of this study was to investigate the clinical utility of radiographs at all time points after internal fixation of lower extremity fractures.
A retrospective chart review was conducted at a level I trauma center. Four hundred eighty-five patients with 586 fractures of the femur, tibia, and ankle were included. Data were analyzed to investigate the effect of radiographs on changes in management at all postoperative time points for each fracture type.
Each fracture received, on average, 4.8 radiographs after fixation for a total cost of $938,469. The management of 31% (179 of 586) of fractures deviated from the expected postoperative course. Of the 179 fractures with a deviation, 93 (31%) resulted from radiographic findings alone and occurred (1) in the immediate postoperative period (2%) and (2) in the period from consideration of advancement to full weight bearing up until confirmation of fracture union (98%). Notable cost savings can be realized by using the findings to eliminate nonclinically indicated imaging at both the institutional and national levels.
Routine radiographs in isolation contribute to changes in management (1) in the immediate postoperative period in select cases and (2) during the period when advancement to full weight bearing is being considered up until clinical fracture union.
Level III.
本研究的目的是调查下肢骨折内固定后所有时间点的 X 线片的临床应用价值。
在一家一级创伤中心进行了回顾性图表审查。共纳入 485 例股骨、胫骨和踝关节骨折患者，共 586 处骨折。分析数据以调查每种骨折类型在所有术后时间点 X 线片对治疗变化的影响。
每个骨折固定后平均接受了 4.8 次 X 线片，总费用为 938469 美元。31%（586 处骨折中的 179 处）的骨折治疗偏离了预期的术后过程。在 179 处有偏差的骨折中，有 93 处（31%）仅因影像学发现而发生，发生在（1）术后即刻（2%）和（2）从考虑负重至完全负重直至确认骨折愈合的时间段（98%）。通过使用这些发现消除机构和国家层面上非临床指征的影像学检查，可以实现显著的成本节约。
孤立的常规 X 线片会导致（1）在某些情况下的术后即刻，以及（2）在考虑负重至完全负重直至临床骨折愈合的时间段内，治疗发生变化。
III 级。
