title: Current Opinions on Fracture Follow-up: A Survey of OTA Members Regarding Standards of Care and Implications for Clinical Research.
abstract: OBJECTIVE
  To determine current practice standards among Orthopaedic Trauma Association surgeons for postoperative fracture follow-up and to investigate the implications of these standards on clinical research.
  
  
  METHODS
  Survey.
  
  
  METHODS
  Web-based survey.
  
  
  METHODS
  One hundred eighty-four orthopaedic trauma surgeons.
  
  
  METHODS
  A web-based questionnaire was distributed to Orthopaedic Trauma Association members to identify standard postoperative radiographic and clinical follow-up duration. Assuming uneventful, complete fracture healing at 3 months, data were collected for 3 generic fracture types (diaphyseal, extra-articular metaphyseal, and intra-articular) and 3 specific fractures (femoral shaft, intertrochanteric, and tibial plateau). Suggested follow-up for clinical research was also investigated.
  
  
  RESULTS
  For extra-articular fractures, standard radiographic and clinical follow-up were considered to be 6 months or less by greater than 70% of respondents. For intra-articular fractures, standard radiographic and clinical follow-up was considered to be 6 months or less by greater than 39% of respondents. The most common responses for radiographic follow-up were 3 months for extra-articular fractures (33%) and 12 months for intra-articular fractures (34%). The most common responses for clinical follow-up were 6 months for extra-articular fractures (37%) and 12 months for intra-articular fractures (35%). The majority (55%) indicated that follow-up to clinical and radiographic healing or the establishment of a nonunion should be the minimum follow-up for clinical fracture studies and 66% recommended follow-up to at least 1 year for functional outcome studies.
  
  
  CONCLUSIONS
  Most surgeons follow-up patients with lower extremity extra-articular fractures (with uneventful healing) radiographically for 3-6 months and clinically for 6 months and slightly longer for intra-articular fractures. Many surgeons cease radiographic and clinical follow-up by 6 months. Therefore, retrospective fracture healing studies can only reasonably expect follow-up for 6 months. Publication requirements for longer follow-up of fracture-related studies would likely eliminated retrospective studies from consideration. Most surgeons support obtaining at least 1-year follow-up for clinical studies that include functional outcome.
  
  
  METHODS
  Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Washington University Orthopaedics, Washington University School of Medicine, St. Louis, MO; †Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA; and ‡Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa General Hospital, Tampa, FL.
authors.forename: William M
authors.initials: WM
authors.lastname: Ricci
authors.forename: James C
authors.initials: JC
authors.lastname: Black
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gardner
authors.forename: Christopher M
authors.initials: CM
authors.lastname: McAndrew
authors.forename: Roy W
authors.initials: RW
authors.lastname: Sanders
mesh_terms: D000328:Adult; D000359:Aftercare / Q000592:standards / Q000706:statistics & numerical data*; D001291:Attitude of Health Personnel; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000601:surgery*; D019538:Health Care Surveys; D006302:Health Services Research / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072161:Orthopedic Surgeons / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000592:standards* / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data; D059039:Standard of Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology