Routine radiography following ankle fracture fixation: a case for limiting its use

The use of fluoroscopic screening in the orthopaedic theatre is a necessary operative aid in many procedures. Modern systems give good image resolution and allow the production of per-operative hard-copy prints. This study was performed to compare these prints with postoperative radiographs in 41 patients who underwent internal fixation for an ankle fracture in a 6-month period. The hard-copy prints and the postoperative X-ray films were independently assessed for several features, which included status of the tibiofibular syndesmosis, fibular length, talo-crural angle, talar tilt, presence and size of a posterior malleolar fracture, and abnormality of the medial clear space. Information was also recorded as to whether there had been a change in postoperative management plan after review of the check X-ray. Of the 41 cases, 30 were suitable for full assessment. In 25 of these cases there was no difference in the information provided by the hard-copy prints from fluoroscopic images and the postoperative check X-rays. In the other five cases, the differences were not significant. In none of the cases did the check X-ray effect a change in postoperative management. We therefore suggest that if per-operative hard-copy prints are obtained from the fluoroscopic images, postoperative radiographs of the ankle are only necessary in exceptional circumstances.