• Kevin Phelps, Michelle Coleman, Rachel Seymour, and Michael Bosse.
• 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.

IntroductionThe goal of this study was to investigate the clinical utility of radiographs at all time points after internal fixation of lower extremity fractures.MethodsA 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.ResultsEach 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.ConclusionRoutine 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 Of EvidenceLevel III.

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