Tayyem Mohammed, Ismail Nizar, Al-Kharouf Khaled F, Jundi Humam, Singh Pallavi, Leech William, Evans Thomas, Elmesalmi Mahmoud, Chennagiri Ramesh
Trauma and Orthopaedics, Buckinghamshire Healthcare NHS Trust, Aylesbury, GBR.
Trauma and Orthopaedics, St George's University Hospitals, London, GBR.
Cureus. 2024 Nov 18;16(11):e73960. doi: 10.7759/cureus.73960. eCollection 2024 Nov.
Distal radius fractures (DRFs) are a common orthopaedic injury, often requiring surgical intervention. Routine postoperative radiographs are frequently obtained after surgical fixation to ensure adequacy of fixation and rule out early complications, yet their necessity remains unclear. Through this study, we tried to evaluate the impact of routine postoperative radiographs on the management of DRFs. The objective was to determine whether routine postoperative radiographs are necessary for the effective management of patients following surgical fixation of DRFs using volar locking plates.
A review of 176 patients who underwent distal radius open reduction and internal fixation with volar locking plates at a UK district general hospital was conducted over a period of two years. Data on patient demographics, fracture characteristics, postoperative imaging new findings, and management changes were collected and analysed. The primary outcome measure was the rate of reoperation based on new findings in the routine postoperative radiographs.
Routine postoperative radiographs were obtained in all the cases, with only 1% (one patient) requiring reoperation based on the presence of new findings on the postoperative radiographs. Approximately 8% (12 patients) experienced a change in their management in the form of prolonged cast immobilization.
Routine postoperative radiographs for DRFs with open reduction internal fixation may have limited impact on management decisions. The study highlights the potential overutilization of postoperative radiographs, leading to increased healthcare costs and radiation exposure. Based on the study's findings, a case-by-case approach, considering fracture type, associated injuries, and clinical indications, is advocated. Reducing the use of routine radiographs could save resources and reduce unnecessary radiation exposure without compromising patient care.
桡骨远端骨折（DRF）是一种常见的骨科损伤，通常需要手术干预。手术固定后经常进行常规术后X线检查，以确保固定充分并排除早期并发症，但其必要性仍不明确。通过本研究，我们试图评估常规术后X线检查对DRF治疗的影响。目的是确定对于使用掌侧锁定钢板手术固定DRF的患者，常规术后X线检查对于有效治疗是否必要。
对一家英国地区综合医院在两年时间内接受桡骨远端切开复位内固定术并使用掌侧锁定钢板的176例患者进行回顾性研究。收集并分析患者人口统计学数据、骨折特征、术后影像学新发现以及治疗变化。主要结局指标是基于常规术后X线检查新发现进行再次手术的发生率。
所有病例均进行了常规术后X线检查，仅1%（1例患者）因术后X线检查出现新发现而需要再次手术。约8%（12例患者）的治疗方式发生了改变，表现为延长石膏固定时间。
对于切开复位内固定的DRF患者，常规术后X线检查对治疗决策的影响可能有限。该研究突出了术后X线检查可能存在的过度使用情况，导致医疗成本增加和辐射暴露增加。基于该研究结果，提倡根据骨折类型、合并损伤和临床指征采取个案处理的方法。减少常规X线检查的使用可以节省资源并减少不必要的辐射暴露，同时不影响患者护理。
