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.

Reply at: Orthopaedic Trauma Association forum

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.
Assistant Professor
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  

Bill Obremskey

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.

Best regards,

Alexander N. Chelnokov
Ural Scientific Institute of Traumatology and Orthopaedics
str.Bankovsky, 7. Ekaterinburg 620014 Russia

Date: Tue, 24 Jun 2003 08:54:54 EDT

From: Aobonedoc


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.

Good luck.

Sincerely and respectively,

M. Bryan Neal, MD
Arlington Orthopedics and Hand Surgery Specialists, Ltd.
1100 W. Central Road, Suite 304
Arlington Heights, Illinois 60005

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.

John Early MD
Assoc. Prof Orthopaedic Surgery
UT Southwestern Medical Center
Dallas Texas

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.

Tom DeCoster