Do Routine Postoperative Radiographs Influence the Management of Distal Radius Fractures Following Volar Locking Plate Fixation?

Mohammed Tayyem; Nizar Ismail; Khaled F Al-Kharouf; Humam Jundi; Pallavi Singh; William Leech; Thomas Evans; Mahmoud Elmesalmi; Ramesh Chennagiri

doi:10.7759/cureus.73960

Do Routine Postoperative Radiographs Influence the Management of Distal Radius Fractures Following Volar Locking Plate Fixation?

Cureus. 2024 Nov 18;16(11):e73960. doi: 10.7759/cureus.73960. eCollection 2024 Nov.

Authors

Mohammed Tayyem¹, Nizar Ismail¹, Khaled F Al-Kharouf², Humam Jundi¹, Pallavi Singh¹, William Leech¹, Thomas Evans¹, Mahmoud Elmesalmi², Ramesh Chennagiri¹

Affiliations

¹ Trauma and Orthopaedics, Buckinghamshire Healthcare NHS Trust, Aylesbury, GBR.
² Trauma and Orthopaedics, St George's University Hospitals, London, GBR.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: distal radius fractures; post-operative imaging; postoperative radiographs; revision rate; volar locking plate; wrist fracture.