In the JournalsPerspective

Omission of routine radiography for distal radius fractures did not affect outcomes

Patients with distal radial fractures who did not undergo routine radiography after 2 weeks of follow-up had similar patient-reported outcomes and risk of complications compared with patients who underwent usual care, according to published results.

Researchers randomly assigned 326 patients with a distal radial fractures to a regimen of either routine radiographs (usual care; n=166) or without routine radiographs (reduced imaging; n=160) at 6 and 12 weeks of follow-up. Researchers assessed outcomes of DASH score, patient-rated wrist/hand evaluation score, health-related quality of life, pain and complications at baseline and after 6 weeks, 3 and 6 months, and 1 year of follow-up.

Results showed the usual care group and reduced imaging group had comparable DASH scores at all time points, as well as overall, with an adjusted regression coefficient of 1.5 for the DASH scores. Researchers also found no differences among patient-rated wrist/hand evaluation scores, EuroQol-5 scores for quality of life and VAS scores for pain at rest or pain when moving between the two groups. Patients in the reduced imaging group had a similar complication rate to patients in the usual care group, according to results. Researchers noted patients in the reduced imaging group underwent fewer radiographs compared with patients in the usual care group.

“The main difference was found in the number of radiographs obtained to detect hard callus formation, which was less frequently confirmed radiographically in the reduced-imaging group, without a negative effect on functional outcome,” the authors wrote. “This provides a cost-saving opportunity for the health care system and a small dose reduction in ionizing radiation.” – by Casey Tingle

Disclosures: van Gerven reports he received grants from ZonMw, The Netherlands Organization for Health Research and Developing. Please see the study for a list of all other authors’ relevant financial disclosures.

Patients with distal radial fractures who did not undergo routine radiography after 2 weeks of follow-up had similar patient-reported outcomes and risk of complications compared with patients who underwent usual care, according to published results.

Researchers randomly assigned 326 patients with a distal radial fractures to a regimen of either routine radiographs (usual care; n=166) or without routine radiographs (reduced imaging; n=160) at 6 and 12 weeks of follow-up. Researchers assessed outcomes of DASH score, patient-rated wrist/hand evaluation score, health-related quality of life, pain and complications at baseline and after 6 weeks, 3 and 6 months, and 1 year of follow-up.

Results showed the usual care group and reduced imaging group had comparable DASH scores at all time points, as well as overall, with an adjusted regression coefficient of 1.5 for the DASH scores. Researchers also found no differences among patient-rated wrist/hand evaluation scores, EuroQol-5 scores for quality of life and VAS scores for pain at rest or pain when moving between the two groups. Patients in the reduced imaging group had a similar complication rate to patients in the usual care group, according to results. Researchers noted patients in the reduced imaging group underwent fewer radiographs compared with patients in the usual care group.

“The main difference was found in the number of radiographs obtained to detect hard callus formation, which was less frequently confirmed radiographically in the reduced-imaging group, without a negative effect on functional outcome,” the authors wrote. “This provides a cost-saving opportunity for the health care system and a small dose reduction in ionizing radiation.” – by Casey Tingle

Disclosures: van Gerven reports he received grants from ZonMw, The Netherlands Organization for Health Research and Developing. Please see the study for a list of all other authors’ relevant financial disclosures.

    Perspective
    David Ring

    David Ring

    Clinicians who care for fractures of the distal radius know that radiographs uncommonly affect management more than 2 weeks after operative or nonoperative treatment. Problems tend to present themselves in other ways and radiographs can tell us more about those problems. These data confirm that it doesn’t affect symptoms, limitations or adverse events to use radiographs selectively beyond 2 weeks after fracture. One caveat is that safety studies should have a larger number of patients to account for uncommon, relatively severe outcomes. For instance, what rate of screw migration leading to flexor tendon rupture is acceptable? What number of unhelpful radiographs is acceptable to catch that one problem?

    Reference:

    Leopold SS. Clin Orthop Relat Res. 2014;doi:10.1007/s11999-014-3675-x.

    • David Ring, MD, PhD
    • Associate dean for comprehensive care
      Professor of surgery and psychiatry
      Dell Medical School
      The University of Texas at Austin
      Austin, Texas

    Disclosures: Ring reports no relevant financial disclosures.