Date: Mon, 23 Jun 2003 14:33:44 EDT
Subject: Maisonneuve Fracture
Could I get a show of hands for when people routinely x-ray post-op patients. For the record, I get post op xrays 2 weeks and 2 days after I fix ankle fractures (in addition to intra-op). I am reviewing a case for a friend and there was reference to "standard of care", which is poorly defined. Anyone willing to commit when you would routinely get a post op xray and what you think the standard of care should be. thank you.
Douglas G. Wright, M.D.
Date: Mon, 23 Jun 2003 11:51:51 -0700
From: Bruce Sangeorzan
We have an institutional standard that the first Xray after ORIF of a fracture is at 6 weeks, unless there is a compelling reason for an earlier evaluation.
Bruce Sangeorzan, MD
Professor of Orthopedics and Sports Medicine
Harborview Medical Center
Date: Mon, 23 Jun 2003 14:58:19 -0400
From: Kevin Pugh
In the OR before you leave the room. Then at the first visit (10-14 days).
Date: Mon, 23 Jun 2003 14:43:37 -0500
From: Anglen, Jeffrey
I get good Xrays on the OR table with the patient asleep and the back table sterile if the fixation is solid and stable and the bone is good quality, I wouldn't ever Xray them again unless there is a clinical indication.
Jeffrey O. Anglen MD FACS
Clinical Professor of Orthopaedics
University of Missouri
Date: Mon, 23 Jun 2003 14:51:47 -0500
From: Frederic B. Wilson, M.D.
I would agree with Bruce. In addition to the on-the-table radiographs at the end of the case, we routinely wait 4-6 weeks for follow-up films.
Frederic B. Wilson, M.D.
Trauma and Adult Reconstruction
Department of Orthopaedic Surgery
Tulane University School of Medicine
New Orleans, LA, 70112
Date: Mon, 23 Jun 2003 16:35:38 -0400
From: Charles M. Blitzer
I get f/u x-ray ~ 10 days (first post op visit). I feel it's nice to document no loss of fixation, nice to have a comparison for f/u later (OR films are not available in the office) However, I'm hard pressed to think of a case where first post-op changed my management.
Date: Mon, 23 Jun 2003 22:27:50 -0500
From: Obremskey, William T
Flouro in OR; 2 weeks when sutures out only if I am concerned about fixation/compliance and at 4-6 weeks when patient to begin WBAT
Date: Tue, 24 Jun 2003 09:28:33 +0600
From: Alexander Chelnokov
We routinely make x-rays at 1, 2, 3, 6 and 12 months. Unless we suspect something unplanned has happened.
Date: Tue, 24 Jun 2003 08:54:54 EDT
I would typically get an xray in my office in the first post op visit or second at the latest. I practice in Cook County, Illinois (extremely litiginous). Tough question about what the "standard of care" is.
Sincerely and respectively,
Date: Tue, 24 Jun 2003 11:35:35 -0500
From: John Early
After patients are stabilized with fixation xrays are taken in the or to confirm alignment. I routinely obtain first post op xray at 6 weeks. The only reason I would obtain xrays sooner would be for noncompliance or post op complication. The patient is then followed 3, 6, and 12 months.
Date: Tue, 24 Jun 2003 14:21:40 -0400
From: Peter Trafton
Doug's original question asks about x-rays after "ankle fxs", but the header says "maisonneuve fracture"
I wonder whether the responders do the same for both injuries? - different answers might come from folks who use different techniques for syndesmosis fixation, including variations in screw size & number, weight-bearing, and how long they feel the screws should be left in place - all of which are determined more by opinion than by clinical science. Do we monitor malleolar fixation differently from syndesmosis fixation?
Post-op, for both, I get standing x-rays at 6 wks, then Q 4-6 weeks until union for those not healed, but if healed, at 3 mos unless doing very well. Then standing films at 1 year. Usually will get films before any hardware removal, or if significantly increased symptoms. My routine syndesmosis fixation for a high PER injury ("Maisonneuve") is with 2 large fragt (4.5mm diam - partially threaded) "malleolar" screws, an inch or two above the syndesmosis, which I've reduced open and tightened just to the point of congruence. I allow weightbearing as tolerated as soon as the wounds are healed, and check x-rays as described at 6 wks, and again at 3 mos, just before recommended (but not required) screw removal.
One person's opinions.
Date: Thu, 26 Jun 2003 14:45:42 -0600
From: Thomas A. DeCoster
I don't know that there is a standard of care for distal fibula fracture radiographs after fixation other than a final intra-operative film and when clinical problems suggest concern.
I suspect most surgeons get radiographs at 6 weeks and somewhere about 4 months when thought to be healed. Additional radiographs by surgeon preference.
Syndesmosis stabilization is fraught with more problems including imperfect reduction, loss of reduction, screw loosening and screw breakage. Therefore I suspect most surgeons get radiographs more frequently after syndesmosis fixation. I would usually get a radiograph at 2 & 6 weeks postoperatively and right before sysndesmosis screw removal if planned (about 12 weeks). There are so many different perspectives on "syndesmosis" that I doubt there is anything close to a "standard of care" for postop radiograph frequency.