Influence of direct radiography in decision making during orthopaedic trauma surgery: A prospective study

To evaluate the effects of intraoperative direct radiography on the change in the patient's treatment and the reliability of fluoroscopy in orthopaedic trauma surgery operations.

A total of 773 fractures were evaluated prospectively. The surgeons involved in the case were divided into three groups according to their experiences: less than 5 years, 5-10 years and over 10 years. After each case, the fracture classification, whether any interventions were made after the X-ray, and the interventions were recorded.

There were 312(40%) intra-articular, 200(26%) metaphyseal, 161(21%) diaphyseal, 81(10%) pelvis-acetabulum, and 19(3%) vertebrae fractures. Surgeons needed to intervene in 71(9.2%) cases after direct-radiography. There was a significant difference between the location of the fracture and the number of interventions (p < 0.001). The most frequent interventions were intra-articular distal radius, acetabulum and intra-articular calcaneus fractures, respectively. Surgeons with more than 10 years of the experience felt the need to make fewer changes, it was statistically significant compared to the other two groups (p = 0.001 for both).

It was found that the final evaluation with x-ray images before the operation was completed in trauma surgery affected the surgeon's decision. In particular, intra-articular fractures, acetabular fractures, and vertebral fractures are recommended to evaluate fixation with direct radiography in addition to fluoroscopy images before ending the operation.

LEVEL III.