非手术治疗孤立性桡骨头骨折随访x线片的比率和效用

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-05-21 DOI:10.1016/j.jhsg.2025.02.018

Carew Giberson-Chen MD , Phillip Grisdela Jr MD , Zina Model MD , Philip Blazar MD , Brandon E. Earp MD , Dafang Zhang MD

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引用次数: 0

摘要

目的：先前的文献表明，尽管大约三分之二的非手术治疗的孤立性桡骨头骨折的随访x线片，但他们通常不会改变治疗方法。本研究的目的是调查目前关于这些损伤的随访x线片的做法以及获得这些研究的效用。方法回顾性分析2016年至2020年在两家一级创伤中心接受非手术治疗的孤立性桡骨头骨折患者。记录患者的详细情况、治疗过程和放射学测量。主要结果是获得随访x线片。次要结果包括随访x线片的数量、间隔骨折移位、计划与非计划的临床预约、最终随访片的x线片愈合、基于随访x线片的管理改变、不愈合和/或转向手术。进行双变量统计分析。结果318例322例孤立性桡骨头骨折患者（92%为Mason I型，8%为Mason II型），其中217例（67%）共随访331组x线片，平均每例骨折1组。关节移位增加和Mason II型分级与随访x线片次数增加有关。根据随访x线片或骨不连或转行手术的记录，没有患者改变治疗方法。中位裂缝位移为0 mm。在计划外就诊的患者中，随访x光片的比例高出11%。结论：与之前的报道相比，非手术治疗孤立性桡骨头骨折的随访x线片的发生率仍然相似，尽管先前的证据表明缺乏实用性。在我们的队列中，随访x线片没有改变治疗方法，间隔位移最小，即使在计划外门诊就诊的患者中也是如此。在这种临床情况下，随访x线片是一种低价值的测试，提供者应该重新考虑获得这些研究的效用。研究类型/证据水平治疗性IV。

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The Rate and Utility of Follow-Up Radiographs for Nonoperatively Treated Isolated Radial Head Fractures

Purpose

Prior literature has shown that although follow-up radiographs are obtained for approximately two-thirds of nonoperatively treated isolated radial head fractures, they generally do not change management. This study aims to investigate the current practice regarding follow-up radiographs for these injuries and the utility of obtaining these studies.

Methods

A retrospective review was performed of patients with isolated radial head fractures initially treated nonoperatively at two Level I trauma centers between 2016 and 2020. Patient details, treatment course, and radiographic measurements were recorded. The primary outcome was the acquisition of follow-up radiographs. Secondary outcomes included the number of follow-up radiographs, interval fracture displacement, planned versus unplanned clinic appointments, radiographic union on final follow-up films, change in management based on follow-up radiographs, and nonunion and/or conversion to surgery. Bivariate statistical analysis was performed.

Results

Of 318 patients with 322 isolated radial head fractures initially treated nonoperatively (92% Mason I, 8% Mason II), 217 (67%) had 331 total sets of follow-up radiographs, with a median of 1 set per fracture. Increased articular displacement and Mason II classification were associated with increased number of follow-up radiographs. No patient had a change in management based on follow-up radiographs or documentation of nonunion or conversion to surgery. Median interval fracture displacement was 0 mm. The rate of follow-up radiographs was 11% higher among patients with unplanned clinic visits.

Conclusions

The incidence of follow-up radiographs for nonoperatively treated isolated radial head fractures has remained similar compared to previous reports, despite prior evidence demonstrating a lack of utility. In our cohort, follow-up radiographs did not change management and interval displacement was minimal, even among patients with unplanned clinic visits. Follow-up radiographs in this clinical scenario are a low-value test, and providers should reconsider the utility of obtaining these studies.