title: Quality and Utility of Immediate Formal Postoperative Radiographs in Ankle Fractures.
abstract: BACKGROUND
  Patients who undergo internal fixation of ankle fractures commonly have postoperative imaging performed immediately after surgery. As these patients typically are typically immobilized, radiographs provide limited visualization. The purpose of this study was to evaluate the utility and quality of formal radiographs performed immediately following ankle fracture surgery.
  
  
  METHODS
  Ankle fractures undergoing open reduction and internal fixation at a single institution from January 1, 2011, to January 1, 2013, were reviewed. Intraoperative and formal postoperative radiographs were evaluated using defined parameters. The postoperative images were compared with the intraoperative fluoroscopic images in terms of quality. Postoperative complications were evaluated in terms of fracture displacement, hardware malpositioning, and need for return to the operating room. A total of 411 patients with 413 ankle fractures underwent surgical fixation, with 271 patients undergoing formal postoperative radiographs.
  
  
  RESULTS
  Twenty-eight patients (10.3%) had 3 good quality postoperative views of the ankle, with the lateral (35.2%) and mortise (41.3%) views least commonly performed with good technique. None of the patients without radiographs had a complication that could have been detected earlier using postoperative radiographs. No patients required return to the operating room based on immediate postoperative radiographs. Postoperative radiographs cost $191 per patient.
  
  
  CONCLUSIONS
  The routine use of formal postoperative radiographs prior to discharge from the hospital did not provide additional value to the patient or orthopedic surgeon. The quality of these images was generally inferior to the quality of those obtained and saved intraoperatively due to malrotation and overlying cast material. To reduce cost and radiation exposure, formal postoperative radiographs should be obtained only in specific circumstances, such as increasing postoperative pain, marginal fixation, or instability.
  
  
  METHODS
  Level III, retrospective cohort study.
authors.affiliation: Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Sara Lyn
authors.initials: SL
authors.lastname: Miniaci-Coxhead
authors.affiliation: Lahey Hospital and Medical Center Orthopaedic Surgery, Burlington, MA, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Martin
authors.affiliation: Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA john_ketz@urmc.rochester.edu.
authors.forename: John P
authors.initials: JP
authors.lastname: Ketz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D001858:Bone Nails; D001860:Bone Plates; D002648:Child; D015331:Cohort Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011786:Quality Control; D000069079:Radiation Exposure / Q000009:adverse effects; D011859:Radiography / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
keywords: ankle fracture; cost; postoperative imaging; radiation exposure; radiographs