Postoperative radiographs after open reduction and internal fixation of mandibular fractures: clinical need or unnecessary radiation?

Abstract

Postoperative radiographs are conventionally taken after open reduction and internal fixation (ORIF) of mandibular fractures, but routine radiographic exposure in patients who have no clinical signs may not be justified. To find out whether radiographs influence immediate postoperative management, and whether they can be used to predict long-term complications, we retrospectively reviewed the radiographs and case notes of 92 patients who had ORIF of isolated mandibular fractures between June 2010 and June 2012. We evaluated them for the adequacy of reduction and fixation using locally agreed criteria, and correlated them with immediate and long-term outcomes as recorded in the case notes. Eleven patients had complications, usually infection. All 4 patients who required repeat ORIF had worrying signs and symptoms despite the immediate postoperative radiograph looking favourable. The radiographs of 7 patients looked unfavourable, but no patient required another operation, and none developed complications. Routine postoperative radiographs after ORIF of mandibular fractures seem to have little value in the management of patients, as the decision to reoperate is based on clinical signs rather than radiographic appearance, and radiographic appearance is not associated with long-term outcomes. Our findings suggest that radiographs are valuable only in patients with clear clinical indications and, in view of the risk and cost of radiation, we question their continued use.