Post-splinting x-rays of non-displaced hand, wrist, ankle, and foot fractures are unnecessary [abstract]
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Background: Acute non-displaced fractures (NDFs) are very common in the ED and some physicians advocate for obtaining postsplinting x-rays to identify potential displacement that can occur during the splinting process. Obtaining these x-rays requires extra time, cost, and radiation exposure to patients. Objectives: Our objectives are (1) to determine how often x-rays are obtained after splinting of NDFs of the hand, wrist, ankle, or foot; (2) to identify if post-splinting x-rays changes treatment management in the ED; (3) to identify if there are medical complication at follow-up in patients that do not receive post-splinting x-rays. Methods: This is a retrospective chart review study of a cohort of
ED patients who were discharged with hand, wrist, ankle, or foot fractures. Electronic medical records were reviewed to determine those patients with NDFs (as read by the reading radiologist) and underwent splinting with or without post-splinting x-rays. Postsplinting x-ray reports were evaluated to determine whether displacement had occurred during the splinting procedure. For the group that did not undergo post-splint x-rays in the ED, follow-up medical records within two month of the initial ED visit (in-network only) were reviewed to assess for follow-up x-rays and management decisions. Results: 265 patients met the study criteria and were included (138 male; age range 1-94; average 37.2). 27 patients (10.2%) had postsplinting x-rays performed in the ED. None of these patients had interval fracture change or management change (i.e. resplinting). 204 patients followed up within our health system. 179 patients underwent x-rays at the clinic follow-up visit. 14 of these patients had interval displacement of the fracture and one of these patients had surgical fixation (bimalleolar ankle fracture). Conclusion: Of the 206 patients who had post-splinting x-rays obtained in the ED or follow-up clinic, 1 (.005%) had change in management based on the interval fracture change from pre-splinting x-rays. Post-splinting x-rays of NDFs do not change ED management of patients and rarely change patient follow-up management.