Post-Splinting Radiographs of Minimally Displaced Fractures: Good Practice or Medicolegal Protection?
Reference: Chaudry S, DelSole EM, Egol KA. Post-Splinting Radiographs of Minimaly Displaced Fractures: Good Practice or Medicolegal Protection? J Bone Joint Surg Am. 2012; 94:e128, 1-5.
Scientific Literature Review
Reviewed by: Matthew German, DPM
Residency Program: University Hospital - UMDNJ
As physicians of the foot and ankle, we evaluate and treat many acute injuries, especially minimally displaced fractures. Following splinting a minimally or non-displaced fracture, many institutes require post-splinting films to evaluate changes in alignment. This study was performed to evaluate the efficacy of post-splinting radiographs and whether they demonstrated change in bony alignment or any change in the management of the patient.
A retrospective review was done of all minimally and non-displaced fractures at the host institution between the time of September 2008 and April 2010. Of these, 204 had post-splinting radiographs obtained. The post-splint radiographs were compared to the pre-splint radiographs and original ER consult notes, to determine if any changes in alignment had occurred after splinting the fracture. A one-tailed, unpaired t-test was performed for statistical analysis.
Of the 204 fractures that received post-splint radiographs, zero showed changed alignment. ER length tended to be about one hour longer for those that received post-splint radiographs than those that did not (8.5 hours vs 7.5 hours). Two splints were reapplied after post-splint radiographs for undocumented reasons. On average, patients received 10 radiographs for each displaced fracture. Post-splint radiographs added an average of three radiographs. The three most common sites of fracture were distal radius/ulna (76), metacarpal and phalanges (55), and the foot and ankle (44).
Post-splinting radiographs of patients with minimally or non-displaced fracture are associated with longer ER length of stay, prolonged radiation exposure, and increased cost to the hospital without providing any change in treatment plan or clinical decision-making. Per the authors of this study, “Routine performance of post-splinting radiographs of non-displaced or minimally displaced fractures should be discouraged.”