Second physician review of radiographs after wrist and ankle reductions offers limited utility to clinical management.

Abstract

The purpose of this study is to determine the clinical utility of second-physician review of radiographs obtained after reduction of distal radius and ankle fractures. Fifty consecutive ankle and distal radius fractures requiring reduction were reviewed. The time from post-reduction radiograph to second-physician interpretation was obtained. The second-physicians' interpretation was evaluated for clinically influential information. Patients requiring a repeat reduction were identified, and the timing of the repeat reduction radiograph was compared with the timing of the second-physician interpretation of the initial post-reduction radiograph. The mean time of second-physician interpretation for post reduction ankle radiographs was 6h and 47min (range 4min to 43h and 3min). Eleven of 50 (22%) interpretations of post reduction ankle radiographs commented on acceptability of reduction. The mean time of second-physician interpretation for post reduction distal radius radiographs was 5h and 34min (range 8min to 22h and 59min). Seven of 50 (14%) interpretations of post reduction distal radius radiographs commented on acceptability of reduction. Three distal radius (6%) and 8 ankle fractures (16%) required repeat reduction. Repeat reductions were completed in 10/11 cases (91%) before the second-physician review of the initial post reduction radiograph was obtained. In only 1 case of repeat reduction was the second-physician review of the post reduction radiograph available before repeat reduction was attempted. The timing and quality of second-physician review of post-reduction radiographs offers little utility to the clinical management of ankle and distal radius fractures.