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Use of Postoperative Radiographs following Operative Fixation of Distal Radius Fractures

Background: Recent studies show that routine postoperative films after open reduction and internal fixation for distal radius fractures rarely alter clinical management. This population study evaluates the use of postoperative radiographs after distal radius fracture fixation. Methods: The authors studied insurance claims from the Truven MarketScan databases to identify patients aged 18 years and older who underwent open reduction and internal fixation for a distal radius fracture between 2009 and 2011. Two years of postoperative data were collected to determine the number and timing of postoperative radiographs and related clinical events, including complications and reoperation. The authors also compared outcomes between cohorts who did and did not undergo radiography on the day of surgery. Results: The authors identified 20,041 patients who met study criteria. On average, 3.8 ± 2.1 radiographs per patient were obtained during the 2-year follow-up, with 3.0 ± 1.4 being obtained within the first 3 months; 59, 81, and 91 percent of patients did not undergo further imaging after 3, 6, and 12 months postoperatively, respectively. Radiographs were obtained on the day of surgery in 47 percent of patients (n = 9372), and more were obtained overall for these patients in the postoperative period (4.4 versus 3.2). Early reoperation rates (within 14 days) following distal radius fractures between patients who did and did not undergo same-day radiography were 5 percent versus 3 percent. Conclusions: On average, four radiographs per patient were obtained following open reduction and internal fixation for a closed distal radius fracture. Nearly 50 percent of individuals underwent radiography on the day of surgery, despite low reoperation rates in the early postoperative period. An evidence-based approach to postoperative radiography has the potential to reduce distal radius fracture–related health care use.