Berk Alexander, Good Logan, Jawanda Harkirat, Florentino Samuel, Albertson Spencer, Clark Robert, Brown Marsalis, Nelson Grant, Wetzel Robert
Department of Orthopedics, University Hospitals Cleveland Medical Center, Cleveland, USA.
Case Western Reserve University School of Medicine, Cleveland, USA.
Eur J Orthop Surg Traumatol. 2025 Apr 4;35(1):146. doi: 10.1007/s00590-025-04266-9.
Early postoperative x-rays are frequently ordered after fracture fixation surgery without clear indication. The purpose of this study was to investigate the utility of early formal x-rays compared to intraoperative fluoroscopy in patients undergoing surgical fixation of pelvic and acetabular fractures.
Adult patients undergoing surgical fixation of pelvic and acetabular fractures at a Level 1 Trauma Center were identified. Early postoperative x-rays were defined as x-rays ordered within 48 h of surgery without clear indication. Two blinded orthopedic surgeons assessed x-rays and fluoroscopic imaging for reduction quality (within 2 mm of anatomic) and accuracy of implant placement. Accuracy of implant placement was categorized as safe, suspicious, or definite implant malposition.
Patients received early postoperative x-rays in 117 cases (53.9%) and fluoroscopy only in 100 cases (46.1%). Among patients undergoing postoperative x-ray, 100% of reductions deemed to have imperfect reduction quality were also deemed to be imperfect on intraoperative fluoroscopy. Similarly, 100% of implants deemed to be of inconclusive safety on postoperative x-ray were also deemed inconclusive on intraoperative fluoroscopy. Considering all patients, 4/117 (3.4%) in the postoperative x-ray group experienced an unplanned change of care within 1 week of surgery vs. 1/100 (1.0%) in the fluoroscopy only group (p = 0.38).
The acquisition of early postoperative x-rays and implant placement accuracy are not reliable predictors of change in care among patients with pelvic and acetabular fractures. Early postoperative x-rays may be unnecessary and should only be ordered with clear clinical indications to improve cost-effectiveness and reduce radiation exposure.
Retrospective cohort study; III.
骨折固定手术后常无明确指征就频繁安排术后早期X线检查。本研究旨在探讨在接受骨盆和髋臼骨折手术固定的患者中，早期正规X线检查与术中透视相比的效用。
确定在一级创伤中心接受骨盆和髋臼骨折手术固定的成年患者。术后早期X线检查定义为在手术48小时内无明确指征而安排的X线检查。两名盲法骨科医生评估X线和透视影像的复位质量（解剖复位2毫米以内）及植入物放置的准确性。植入物放置的准确性分为安全、可疑或明确的植入物位置不当。
117例患者（53.9%）接受了术后早期X线检查，100例患者（46.1%）仅接受了透视。在接受术后X线检查的患者中，所有被认为复位质量欠佳的复位在术中透视时也被认为欠佳。同样，所有在术后X线检查中被认为安全性不确定的植入物在术中透视时也被认为不确定。考虑所有患者，术后X线检查组中有4/117（3.4%）在术后1周内经历了计划外的治疗变更，而仅接受透视组中有1/100（1.0%）（p = 0.38）。
术后早期X线检查及植入物放置准确性并非骨盆和髋臼骨折患者治疗变更的可靠预测指标。术后早期X线检查可能不必要，仅应在有明确临床指征时安排，以提高成本效益并减少辐射暴露。
回顾性队列研究；III级
