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The Utility of Intraoperative X-Rays After Fracture Fixation

Wade Karam

University of Texas Medical Branch

Introduction: Postoperative x-rays (XR) are commonly taken in the recovery room or clinic after fracture fixation, but the utility of taking intraoperative XRs prior to the termination of anesthesia is unknown. The goal of this study is to evaluate the use of intraoperative hard-copy XRs in identifying a problem that necessitates a change in management. Methods: The authors retrospectively reviewed the 2-year experience of an orthopaedic trauma surgeon at a single center who uses intraoperative XR after fracture fixation. Basic demographic analysis was performed. Results: 173 patients met our inclusion criteria. 100% of these patients received intraoperative XRs after fracture fixation. Intraoperative XR identified 2 (1.1%) cases that required a change in management, both were femoral neck fractures. In one case, XR showed that the antirotation screw threads traversed the fracture, which was exchanged for a partially threaded screw. In the other case, 2 screws lost fixation leading to fracture displacement and the screws were exchanged for 2 fully threaded screws. Conclusions: This is the first study analyzing the utility of intraoperative hard copy XRs in the setting of orthopaedic trauma. We retrospectively reviewed 173 patients and identified 2 patients undergoing open reduction internal fixation of femoral neck fractures in which intraoperative XRs identified a need for change in management. Specifically, XR identified a complication 1% of the time not seen on fluoroscopy as well as early loss of reduction that necessitated re-operation. Based on our findings, we propose performing post-fixation XRs in the OR during the same anesthesia event for many reasons: It may be safer for the patient because any problems necessitating further surgical treatment can be performed without the risks of reinduction of anesthesia and reintubation. We will not be subjecting postoperative patients to unnecessary pain in order to receive the appropriate views after fixation. Physicians will be in the room to ensure correct views are obtained. There will be less strain on hospital staff because radiology technicians will already be present in the operating room. While this single surgeon experience shows that intraoperative XR could uncover errors in primary fixation prior to the patient leaving the operating room, further studies are needed to support its use.

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