How Feasible Are Digital Intraoperative Plain Radiographs in Orthopaedic Trauma Surgery?

The purpose of this study is to evaluate the feasibility and outcomes of obtaining routine intraoperative plain radiographs during orthopaedic trauma surgery. Seventy consecutive orthopaedic trauma patients in which intraoperative plain films were obtained in addition to fluoroscopy were reviewed. For each patient the time it took to obtain intraoperative plain radiographs was prospectively measured, in addition to the number of images taken, and quality of image. Then relative imaging times based on fracture locations were compared and the need for revision surgery based on mal-reduction or implant mal-positioning assessed. The average time required for intraoperative plain films to be obtained and reviewed by the surgeon was 3 minutes and 45 seconds. On average, 2.8 images were taken during each surgery. Proximal images took on average 44 seconds longer than distal images to obtain (p = 0.047). There was no significant difference in imaging times for upper versus lower extremities (p = 0.448). High quality images were obtained on all patients. There were no re-operations required in this series for mal-reduction of fracture, mal-positioning of implants or infection. In this study, there were no re-operations or perioperative complications when intraoperative plain films were obtained. Intraoperative plain films are a valuable tool for complex periarticular surgery or other cases where fracture reduction or implant location may be in question. (Journal of Surgical Orthopaedic Advances 32(3):160-163, 2023).