The cost of screening radiographs after stable fracture fixation.

BACKGROUND: Currently up to 58% of Canadian surgeons would forego screening radiographs after stable fracture fixation. It is therefore expected that reducing screening radiographs will be well accepted, provided that patient safety is not compromised, resulting in a cost reduction. The study objective was to measure the savings of a simplified radiographic protocol for well-fixed fractures and establish feasibility for a noninferiority trial that proves patient safety.

METHODS: Patients were randomized after fixation. The control group received screening radiographs immediately after fixation and at 2 weeks. The experimental group received radiographs only when clinically indicated. At 6 weeks all patients received radiographs. The cost of imaging, time spent in clinic and patient satisfaction was measured. A blinded reviewer documented adverse events, either detected or missed.

RESULTS: Of the 90 patients screened, 39 were randomized and 26 had complete follow-up. The mean cost of radiographs over the first 6 weeks was $44.51 (95% confidence interval [CI] 38.64-50.38) per patient in the experimental group, and $129.23 (95% CI 120.23-138.23) in the control group (p < 0.001). The mean time spent in clinic at 2 weeks was 46 min (95% CI 32-60) per patient for the experimental group and 68 min (95% CI 55-81) for the control group (p = 0.018). Two complications occurred in the experimental group. Both were detected clinically and did not qualify as missed events.

CONCLUSION: Implementing a simplified radiography protocol after stable fracture fixation saves time and money. Additionally, no adverse events were missed with the study protocol. Recommendations are made toward a noninferiority trial to establish protocol safety.