Clinical impact of early postoperative routine radiology in isolated pelvic injuries: a retrospective study

The clinical value of routine immediate postoperative conventional radiography following surgical fixation of pelvic fractures remains debated. This study assessed the impact of early postoperative X-rays on management decisions and revision surgery in patients with isolated pelvic ring or acetabular fractures.

We conducted a retrospective cohort study at a Level 1 trauma center, including adults undergoing surgical treatment for isolated pelvic ring or acetabular fractures between 2020 and 2023. All patients received high-quality intraoperative fluoroscopy and postoperative conventional radiographs. The primary outcome was any change in standard postoperative care based on radiographic findings. The secondary outcome was revision surgery prompted by conventional postoperative imaging.

A total of 216 patients were included (median age 63 years), with 156 pelvic ring injuries and 60 acetabular fractures. Postoperative radiographs were obtained at a median of 3 days post-surgery. Changes in postoperative care based on radiographs occurred in 2 patients (3.3%) within the acetabular fracture group. Revision surgery triggered by conventional imaging was required in 1 patient (0.6%) among pelvic ring injuries. In all cases, additional CT imaging preceded definitive management changes.

Routine immediate postoperative conventional radiography after surgical treatment of isolated pelvic fractures has minimal clinical impact. These findings support a shift toward selective, indication-based postoperative imaging, including targeted imaging in cases of poor intraoperative bone quality, anticipated noncompliance with protective mobilization protocols, particularly among geriatric patients, for whom the long-term consequences of radiation exposure may be of secondary importance, or limited intraoperative image quality.