title: Utility of Postoperative Imaging in Radial Shaft Fractures.
abstract: BACKGROUND
  Postoperatively, radial shaft fractures are often followed clinically with serial radiographs to assess for fracture healing. Currently, there is no standard of care regarding postoperative imaging for these injuries. The purpose of this study is to determine whether imaging influences management decisions.
  
  
  METHODS
  Patients who presented to a level I trauma center between 2009 and 2014 with an operatively treated radial shaft fracture were retrospectively screened for inclusion in our study. Patients with ipsilateral ulna or radius fractures, or with inadequate imaging or inadequate follow-up, were excluded. Four blinded, board-certified, orthopedic surgeons reviewed the postoperative films twice for each patient and stated whether the imaging would influence management decisions. Images were separated into 3 groups based on time from surgery: 0 to 4 weeks, 4 to 8 weeks, and greater than 8 weeks. The number of times imaging influenced these hypothetical management decisions was recorded. Interobserver and intraobserver agreements were calculated using Fleiss's and Cohen's kappa coefficients, respectively.
  
  
  RESULTS
  One hundred eighteen patients underwent operative fixation for an isolated radial shaft fracture, of whom 38 met inclusion criteria. Imaging from 0 to 4 weeks, 4 to 8 weeks, and greater than 8 weeks postoperatively resulted in a change of management in 0%, 32%, and 16% of patients, respectively. After 4 weeks, changes were primarily for immobilization and activity-level modification. Intraobserver and interobserver agreement kappa coefficients were 0.761 and 0.563, respectively.
  
  
  CONCLUSIONS
  Films obtained within 4 weeks of surgery for radial shaft fractures are unlikely to change postoperative management and may not be warranted during routine postoperative follow-up.
authors.affiliation: Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Pannell
authors.affiliation: Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: Ram K
authors.initials: RK
authors.lastname: Alluri
authors.affiliation: Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: Lakshmanan
authors.initials: L
authors.lastname: Sivasundaram
authors.affiliation: Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: Nathanael
authors.initials: N
authors.lastname: Heckmann
authors.affiliation: Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: Alidad
authors.initials: A
authors.lastname: Ghiassi
keywords: Galeazzi; fracture; operative; radiographs; radius