X-ray Follow-up after Open Reduction Internal Fixation of Distal Forearm Fracture

Background Following surgery, the standard regimen for fractures of the distal forearm includes radiographs taken 2-weeks postoperatively. However, it is unclear whether these radiographs have any therapeutic risks or benefits for patients.

Objective The purpose of this study is to determine the importance of radiographs taken 2-weeks after surgery on distal forearm fractures, especially if it leads to further operations, and to establish whether this practice should be continued.

Materials and Methods This is a retrospective cohort study of patients with a distal forearm fracture treated surgically with a volar locking plate at two university hospitals in Denmark. Standard aftercare at both departments is 2 weeks in a cast. Patients attend a 2-week follow-up, at which the cast is replaced with a removable orthosis and radiographs are taken. It was recorded whether these radiographs had resulted in any change of treatment in terms of further operations, prolonged immobilization, additional clinical follow-up, or additional diagnostic imaging.

Results A total of 613 patients were included in the study. The radiographs led to a change of standard treatment for 3.1% of the patients. A second operation was required by 1.0%; 0.5% were treated with prolonged immobilization, and 1.6% had additional outpatient follow-up due to the findings on the radiographs. Additional diagnostic imaging was performed on 1.9% of the patients.

Conclusion The radiographs taken at the 2-weeks follow-up resulted in a change of treatment in 3.1% of the cases. Given the low cost and minimal risk of radiographs of an extremity, we concluded that the benefits outweigh the costs of routine radiographs taken 2 weeks after surgical treatment of distal forearm fractures.