Sat., 10/15/11 Peds, Ger, Hip, Femur & IP, Paper #80, 11:43 am OTA-2011
Postsplinting Radiographs of Minimally Displaced Fractures: Good Medicine or Medicolegal?
Sonia Chaudhry, MD; Edward M. DelSole, BS; Kenneth A. Egol, MD;
NYU Hospital for Joint Diseases, New York, New York, USA
Purpose: Many institutions perform radiographic documentation following orthopaedic splint application even in the case when no manipulation has been performed. The purpose of this study was to evaluate the utility of postsplinting radiographs of acute minimally displaced fractures that do not undergo manipulation. Our hypothesis is that postsplinting radiographs do not demonstrate changes in fracture alignment or impact the management of the patient.
Methods: After IRB approval was obtained, consults performed by orthopaedic residents at a Level 1 trauma center from September 2008 to April 2010 were reviewed. Of 2862 consults, 1321 involved acute fractures that were splinted. Radiographs revealed 342 fractures (25.9%) that were minimally displaced and angulated (defined as <5 mm and <10°, respectively). Consults were reviewed to ensure patients had not undergone manipulation prior to or during splinting. Consult notes and radiographs taken in the emergency department, as well as follow-up radiographs, were reviewed to assess ultimate outcome.
Results: None of the 204 fractures (134 nondisplaced and 70 minimally displaced/angulated) demonstrated changes in alignment following splint application. Two splints were reapplied and reimaged for undocumented reasons. Patients were subjected to an average of 10 radiographs (range, 4-25) of their extremities. On average, 3 postsplinting radiographs (range, 1-10) were performed. The mean time between initial and postsplinting radiographs was 3 hours and 30 minutes (range, 9 minutes-24 hours). The most common injury was fractures about the hand or wrist. These 121 patients waited almost 3 hours for an average of 3 additional postsplinting radiographs, contributing to a total of 9 radiographs performed acutely. Emergency department visits were longer for patients with postsplinting radiographs compared to those without (P = .06). Follow-up radiographs were available for 82 patients. All fractures demonstrated maintained alignment.
Conclusions: Postsplinting radiographs of nondisplaced and minimally displaced fractures that do not undergo manipulation before or during immobilization result in longer waits, additional radiation exposure, and increased healthcare costs without providing helpful information. While certain circumstances may call for additional imaging, the routine performance of postsplinting radiographs should be discouraged.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.