Researchers were granted permission to examine orthopaedic consultations in a trauma center for nearly two years.  They initially believed that post-splinting radiographs of acute non-displaced or minimally displaced fractures did not impact patient management or demonstrate changes in the fracture alignment, but they sought evidence to confirm their theory.

From September 2008 to April 2010 the level-1 trauma center had 1,321 consultations involving acute fractures that were splinted.  342 of those cases involved non-displaced or minimally displaced fractures, and 204 of those consultations were assessed with radiographs post-splint.

Of the 204 non-displaced or minimally displaced fractures, none of the radiographs revealed alignment changes after splinting.

Not only were an average of three post-splinting radiographs obtained for each individual, but the mean time between initial and post-splinting radiographs was three hours and thirty minutes.

The most common injury in the study was a hand/wrist fracture.  In these consultations, patients waited an average of nearly three hours for their post-splinting radiographs.  Not surprisingly, ER visits for patients with post-splinting radiographs tended to be longer than those without post-op radiographs.

In their conclusion, researchers noted that some circumstances require additional radiography, but additional imaging for non-displaced or minimally displaced fractures should be avoided to save time and money.

Dr. Silverman Comments

I have always felt that post-splinting radiographs were a complete waste of time and money.

In select cases, doctors are trained to take x-rays to prove they placed a cast on their patient, but in the above cases additional radiography provides no essential benefits.

I applaud these authors for their research and hope their work leads re-evaluation of radiography procedures in health care facilities.  Not only would it save money, but it would save children and adults from unnecessary radiation exposure.

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