C I Mercure1, T C Hardcastle2, A G L Rocher3. 1. Orthopaedic Registrar, Department of Orthopaedics-, Nelson R Mandela School of Medicine, Department of Orthopaedics, Nelson R Mandela School of Medicine, UKZN. Electronic address: chris_mercure@hotmail.com. 2. Trauma-Critical Care surgeon, Head Clinical Department and Director/Chief Trauma Surgeon: IALCH Trauma Service and Trauma ICU, Department of Surgery, Nelson R Mandela School of Medicine, UKZN. Electronic address: Hardcastle@ukzn.ac.za. 3. Head Clinical Unit, Department of Orthopaedics- Nelson R Mandela School of Medicine, UKZN.
Abstract
BACKGROUND: Radiographic imaging remains a cornerstone of orthopaedic practice. Traditional control X-Rays are routinely requested after procedures. These X-rays may add little value in post-op evaluation of trauma ICU patients, in light of intra-operative screening already performed and reviewed, but has high potential morbidity risk. AIM: The aim is to determine if patients undergoing extra-articular fracture fixation, with fluoroscopic image guidance, require any management change due to immediate check x-rays findings. METHOD: Electronic patient and imaging records from January 2015 to November 2019 at a Trauma-specific ICU at a Trauma Society of South Africa accredited, Level 1 Trauma Unit were reviewed retrospectively. All patients matching the inclusion criteria were evaluated to determine if there were any complications and changes in management after the check X-Rays. RESULTS: There were 103 ICU patients identified with a mean age of 32 years (3 to 94). Fifty-seven percent had fluoroscopy images as well as post-operative check x-rays and 51.5% had only check X-rays. Only two cases needed revision surgery based on the control x-ray findings. The post-operative x-ray did not alter the management of 98.1% of our patients. CONCLUSION: In this study, routine post-op check x-rays did not add significant additional information to warrant early additional surgical intervention especially in ICU patients with adequate intra-operative fluoroscopy images. This investigation should be ordered for individual patients based on clinical grounds. This will help minimize patient exposure to avoidable radiation, labour intensive transfers to the radiology department, and decrease investigations that have financial implications but with limited benefits.
BACKGROUND: Radiographic imaging remains a cornerstone of orthopaedic practice. Traditional control X-Rays are routinely requested after procedures. These X-rays may add little value in post-op evaluation of trauma ICUpatients, in light of intra-operative screening already performed and reviewed, but has high potential morbidity risk. AIM: The aim is to determine if patients undergoing extra-articular fracture fixation, with fluoroscopic image guidance, require any management change due to immediate check x-rays findings. METHOD: Electronic patient and imaging records from January 2015 to November 2019 at a Trauma-specific ICU at a Trauma Society of South Africa accredited, Level 1 Trauma Unit were reviewed retrospectively. All patients matching the inclusion criteria were evaluated to determine if there were any complications and changes in management after the check X-Rays. RESULTS: There were 103 ICU patients identified with a mean age of 32 years (3 to 94). Fifty-seven percent had fluoroscopy images as well as post-operative check x-rays and 51.5% had only check X-rays. Only two cases needed revision surgery based on the control x-ray findings. The post-operative x-ray did not alter the management of 98.1% of our patients. CONCLUSION: In this study, routine post-op check x-rays did not add significant additional information to warrant early additional surgical intervention especially in ICU patients with adequate intra-operative fluoroscopy images. This investigation should be ordered for individual patients based on clinical grounds. This will help minimize patient exposure to avoidable radiation, labour intensive transfers to the radiology department, and decrease investigations that have financial implications but with limited benefits.
Authors: Sandip Singh Saggi; Le Zhi Dexter Kuah; Lee Chuen April Toh; Mohammad Taufik Bin Mohammad Shah; Merng Koon Wong; Hamid Rahmatullah Bin Abd Razak Journal: BMJ Open Qual Date: 2022-03