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Omitting Routine Radiography of Traumatic Ankle Fractures After Initial 2-Week Follow-up Does Not Affect Outcomes:

P van Gerven1, P Krijnen1, W P Zuidema2

  • 1Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands.

The Journal of Bone and Joint Surgery. American Volume
|July 1, 2020
PubMed
Summary
This summary is machine-generated.

Routine follow-up radiographs after an ankle fracture can be reduced without negatively impacting clinical outcomes. This reduced imaging approach is safe and effective, decreasing the number of radiographs needed for ankle fracture patients.

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Area of Science:

  • Orthopedic surgery
  • Radiology
  • Evidence-based medicine

Background:

  • The clinical value of routine follow-up radiographs for ankle fractures is debated.
  • Previous studies have not clearly defined the consequences of omitting routine imaging.

Purpose of the Study:

  • To determine if routine radiographs at 6 and 12 weeks post-ankle fracture can be omitted without compromising clinical outcomes.
  • To assess the impact of reduced imaging on patient-reported outcomes and complication rates.

Main Methods:

  • A multicenter, noninferiority randomized controlled trial involving 246 patients with ankle fractures.
  • Comparison of a routine-care imaging group (n=128) versus a reduced-imaging group (n=118).
  • Outcomes assessed included Olerud-Molander Ankle Score (OMAS), AAOS scores, HRQoL, pain, and complications over 52 weeks.

Main Results:

  • Reduced imaging was noninferior to routine care for OMAS scores (difference [β], -0.9; 95% CI, -6.2 to 4.4).
  • No significant differences were found in secondary outcomes such as AAOS scores, HRQoL, pain, or self-perceived recovery.
  • The reduced-imaging group received fewer radiographs (median 4 vs. 5), with similar complication rates (27.1% vs. 22.7%).

Conclusions:

  • A reduced-imaging protocol for ankle fractures shows no adverse effects on functional outcomes, pain, or complications within the first year.
  • Implementing a reduced-imaging strategy can effectively decrease the number of follow-up radiographs needed.
  • This approach supports evidence-based practice in managing ankle fractures.