Falling into the “well, duh” sort of category that cuts through the dogmatic haze, this article examines the ordering of post-reduction radiographs in the Emergency Department.
Specifically, this group of orthopedists from New York City looks at X-ray utilization and length-of-stay after consultation and management of minimally displaced, minimally angulated extremity fractures. They note that, of 342 fractures meeting study criteria, 204 of them subsequently received post-splinting radiography. They note that none of the patients receiving post-reduction radiography had any change in alignment or change in splint application, and this practice resulted in significantly longer ED length-of-stay.
This leads them to their conclusion that minimally displaced, minimally angulated extremity fractures that do not receive manipulation when splinting should not be re-imaged after splint application. And, this seems like a fairly reasonable conclusion. It’s retrospective, the outcomes are surrogates for patient oriented-outcomes, etc., and it would be reasonable to re-evaluate this conclusion in a prospective trial – but if your practice is already to not routinely re-image, this supports continuing your entirely reasonable clinical decision-making.
“Post-Splinting Radiographs of Minimally Displaced Fractures: Good Medicine or Medicolegal Protection?”
http://jbjs.org/article.aspx?articleid=1356145