• Florian Oehme, Valerie Kremo, VeelenNicole vanNV, Julia Mühlhäusser, Jonas Brunner, Jesse Peek, Bryan J M van de Wall, Björn-Christian Link, Matthias Knobe, Reto Babst, and Frank J P Beeres.
• Department for Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland; Department for Visceral, Thoracic and Vascular Surgery, Carl Gustav Carus Dresden University Hospital, Technical University, Dresden.
• Dtsch Arztebl Int. 2022 Apr 22; 119 (16): 279284279-284.

BackgroundThe utility of routine x-rays after the osteosynthesis of distal radius fractures and ankle fractures is questionable. We performed a trial to determine whether such x-rays are justified in patients who have undergone standardized imaging with C-arm fluoroscopy during surgery.MethodsPatients requiring surgery for a distal radius fracture or an ankle fracture were candidates for inclusion in this prospective, randomized, controlled, non-blinded trial. Standardized intraoperative images were obtained with C-arm fluoroscopy and stored at the end of the operation. The next day, patients in the control group underwent imaging with a standard postoperative x-ray, while those in the intervention group did not. The primary endpoint was a change in the treatment plan, defined as additional imaging or a second operation. The secondary endpoints included the range of motion, pain as rated on the Visual Analog Scale, and a functional outcome analysis (PRWE/FAOS).Results316 patients were included in the trial (163 in the control group, 153 in the intervention group), of whom 202 (64%) had radius fractures and 114 (36%) had ankle fractures. The treatment plan changed in twelve patients (3.8%; four in the control group and eight in the intervention group), seven of whom (2.2%; three in the control group and four in the intervention group) underwent a second operation. The frequency of changes in the treatment plan and of reoperations was comparable in the two groups (p = 0.36). On follow-up at six weeks and one year, the results with respect to functional outcomes and pain were comparable.ConclusionIn this trial, routine postoperative x-rays after the osteosynthesis of distal radial fractures and ankle fractures did not improve the care of patients who had undergone standardized intraoperative imaging.

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