A Prospective Trial Comparing the Cost of Post Operative X-rays for Fractures Treated With Stable Internal Fixation

University of Manitoba39 enrolled

Overview

The standard post-operative radiographic protocol for the monitoring of fractures at HSC includes post-operative in hospital radiographs as well as radiographs at the two week follow up appointment. This is in addition to good quality intra-operative radiographs. With current operative techniques and implants, orthopaedic surgeons can achieve reliably stable internal fixation. In fact, patients are often allowed to take weight through the fractured limb immediately post-operatively. In these cases, redundant post-operative radiographs likely represent an avoidable cost to the system financially, and an avoidable cost to the patient in additional time spent in hospital and unnecessary radiation exposure.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Simplified Postoperative Radiographs

Interventions

Treatment group: these patients will not have routine post-operative in hospital radiographs, or radiographs in clinic at two weeks. After examining the patient, the surgeon or resident can order radiographs if required at any time. The decision will be made based on patient complaints of increased pain, appearance of abuse of the splint or cast suggesting lack of compliance or visible clinical deformity of the limb. The reason leading to radiographs will be documented by the ordering physician. If radiographs are ordered based on a wound complication, this will be specifically documented. Radiographic findings will be documented on a form identical to that used for the control group.

Eligibility

Sex: ALLMin age: 17 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Femur fracture treated with intramedullary nailing * Tibia fracture treated with intramedullary nailing * Ankle fractures treated with standard compression technique * Humeral shaft fractures treated with standard compression technique * Forearm fractures treated with standard compression technique * One or both bones fractured * Simple fracture or presence of single butterfly fragment treated with lag screw * Clavicle fracture treated with standard compression technique * Olecranon fracture treated with standard compression technique Exclusion Criteria: * Age \< 17 years, or open growth plates * Multiple orthopaedic fractures * History of radiographic appearance of osteoporosis or osteopenia or poor operative bone quality * Likely difficult with follow-up in first 6 weeks * Same day surgery case * Surgeon feels patient should be excluded

Outcomes

Primary Outcomes

cost-effectiveness of a simplified post-operative radiographic protocol for selected fractures

Cost-effectiveness will be measured by calculating cost of x-ray, patient care and time spent by patient in clinic.

Time frame: post-operative day one or two in hospital, as well as in clinic at two and six weeks

Secondary Outcomes

Patient satisfaction

Validated Patient Satisfaction Questionnaire to be used to measure patient satisfaction with a simplified post-operative radiographic protocol.

Time frame: At six weeks post-op