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Study: Postoperative imaging after fracture fixation may be unnecessary
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CHICAGO —According to data presented here at the International Federation of Foot & Ankle Societies Triennial Meeting, postoperative radiographs offer no significant benefit over intraoperative imaging for patients after ankle fractures.
“We feel that formal radiographs [postoperatively] are redundant,” said Sara Lyn Miniaci-Coxhead, MD. “They add extraneous cost and did not alter the clinical course.”
Miniaci-Coxhead and colleagues retrospectively reviewed 411 patients with 413 ankle fractures who had open reduction and internal fixation at a single institution between January 2011 and January 2013. Overall, 271 patients underwent formal postoperative images, which were used to determine if three quality anteroposterior, lateral and mortise views were available. These images was compared with saved intraoperative fluoroscopic images for accuracy and quality. An analysis was then performed to determine the overall cost of postoperative radiographs on a per patient basis.
Overall, 28 patients (10.3%) had three quality postoperative radiographs. The amount of quality intraoperative images (721, 80.3%) was significantly higher than the amount of quality postoperative radiographs (400 images, 50.1%). Postoperative images did not offer any significant advantages in visualization of fracture, observed complications, malalignment or hardware malposition over intraoperative images.
“Formal radiographs did not provide additional information nor were they of superior quality,” she said. “We feel this may have something to do with positioning the patient postoperatively either due to pain or difficulty assessing the patients’ rotation while they are in the splint.”
Miniaci-Coxhead said one patient had displacement on postoperative radiographs but not the intraoperative images. Additionally, postoperative radiographs increased the total cost by $191 per patient.
“We feel these results can be extrapolated to other areas of orthopedics where splints overlie the area of interest, such as foot and ankle reconstruction or elbow fracture fixation,” Miniaci-Coxhead said. —by Christian Ingram
Reference:
Miniaci-Coxhead SL. The quality and utility of routine immediate postoperative radiographs following ankle fracture surgery. Presented at: International Federation of Foot & Ankle Societies Triennial Meeting; Sept. 19-21, 2014; Chicago.
Disclosure: Miniaci-Coxhead has no relevant financial disclosures.