title: Postoperative Computed Tomography for Articular Fractures: A Systematic Review.
abstract: OBJECTIVE
  To determine the current published patterns of computed tomography (CT) use postoperatively in peri-articular fractures and identify those populations whereby postoperative CT changes management or results in better clinical outcomes.
  
  
  METHODS
  Systematic review of MEDLINE and Cochrane using a combination of key words, including fracture fixation, fracture healing, and computed tomography. The final update search was performed on May 20, 2015. The search was limited to English language publications of human studies from the past 20 years.
  
  
  METHODS
  Eligible studies enrolled internally fixed peri-articular fractures in adults imaged routinely with postoperative CT. Facial and spinal fracture studies were excluded.
  
  
  METHODS
  One thousand five hundred thirty-seven articles were identified using the search strategy. One thousand two hundred ninty-seven articles were excluded by title. One hundred eighty-three studies were excluded by abstract. Fifty-seven full text articles were assessed for eligibility, 31 studies were eligible for study inclusion.
  
  
  RESULTS
  There was no intention to perform combined statistical analysis in the form of a meta-analysis as disparity was anticipated between study populations, interventions, and outcome measures. Routine CT use postoperatively in peri-articular fractures is limited to countries within the developed world, predominantly imaging the lower limb. Only 5 studies detailed postoperative CT leading to a change in patient management; within this pool, only 8 of the 361 individual patients received management changes due to CT scan findings.
  
  
  CONCLUSIONS
  Use of postoperative CT in peri-articular fracture fixation has been demonstrated with minimal evidence, this leads to improved clinical outcomes. Based on available literature, postoperative CT scan use is questionable without convincing evidence of benefit. More research is required to identify selected patients who benefit from postoperative CT imaging.
  
  
  METHODS
  Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, Australia.
authors.forename: Samantha
authors.initials: S
authors.lastname: Stott
authors.forename: Zsolt J
authors.initials: ZJ
authors.lastname: Balogh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review; D055815:Young Adult