gms | German Medical Science

Objectives: In most hospitals acquiring postoperative X-rays after operative treatment of a fracture is the standard. The cost of such X-rays is about 170 swiss francs. The aim of this study was to evaluate if there is a change in treatment plan due to the postoperative X-ray one day after operative treatment of clavicular fractures when standardized intraoperative images were acquired.

Methods: This was a retrospective cohort study performed in a level I trauma center. All consecutive patients treated surgically for clavicular fractures between 2014 and 2018 were included. The primary outcome was any deviation from the standard postoperative protocol resulting from the postoperative X-ray taken one day after surgery. Secondary outcomes included all other complications and re-interventions performed during follow-up unrelated to the primary endpoint.

Results: In total 241 patients were included in the study with a mean age of 45 years (SD 17). 65.6% were treated with anterior, 22.8% with superior plating and 11.2% with nailing. None of the included patients had abnormalities on the postoperative X-ray necessitating re-intervention or deviation from standard postoperative protocol. Seven patients (2.9%) had a deep postoperative late infection: one was detected at the time of implant removal and six during revision for nonunion. Six patients (2.5 %) had aseptic complications: four with non-union and two with implant failure. One-hundred and seven patients (44.4%) had an implant removal due to irritation after consolidation: sixty-nine out of 158 with an anterior plate,20 out of 55 with a superior plate and 18 out of 27 with a nail.

Conclusion: Routinely performing postoperative X-rays after osteosynthesis and standardized intraoperative imaging for clavicula fractures seems unnecessary. Refraining from performing unnecessary radiographs will have a beneficial effect on costs, length of hospital stay, healthcare consumption and decrease exposure to radiation.