The need for routine postoperative radiographs in hip fracture fixation: an audit-based approach

Abstract

This study was designed to establish whether obtaining routine postoperative radiographs following dynamic hip screw (DHS) fixation served any useful clinical purpose. Fifty orthopaedic units in United Kingdom were randomly selected and surveyed, 18 of which routinely obtained check radiographs following DHS fixation. In our unit, routine postoperative films were being performed despite adequate image intensifier images being obtained and printed in theatre. In this study, 174 DHS fixations were reviewed and assessed for adequacy of image intensifier images by comparing them with formal postoperative radiographs. Hundred and fifteen of the 174 original fractures were deemed stable and showed no change of position of fracture or metal work on the postoperative films. Fifty-nine fractures were unstable, and of these, 14 were shown to have medialization of the femoral shaft on the postoperative radiographs as compared with the image intensifier images. The case notes of 132 of the total number of cases were reviewed and none of these patients underwent a change in postoperative mobilization status based on postoperative radiographic findings. These included the 14 unstable fractures. We conclude that obtaining routine check postoperative radiographs after DHS fixation is unnecessary provided adequate image intensifier images are obtained at the time of surgery.