Omitting Routine Radiography of Traumatic Distal Radial Fractures After Initial 2-Week Follow-up Does Not Affect Outcomes

Gerven, P. van; Moumni, M. el; Zuidema, W.P.; Rubinstein, S.M.; Krijnen, P.; Tulder, M.W. van; ... ; Warrior-Trial Study Grp (2019)

Article / Letter to editor

Background: Routine radiography in the follow-up of distal radial fractures is common practice, although its usefulness is disputed. The aim of this study was to determine whether the number of radiographs in the follow-up period can be reduced without resulting in worse patient outcomes.Methods: In this multicenter, prospective, randomized controlled trial with a non-inferiority design, patients >= 18 years old with a distal radial fracture could participate. They were randomized between a regimen with routine radiographs at 6 and 12 weeks of follow-up (usual care) and a regimen without routine radiographs at those time points (reduced imaging). Randomization was performed using an online registration and randomization program. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcomes included the Patient-Rated Wrist/Hand Evaluation (PRWHE) score, health-related quality of life, pain, and complications. Outcomes were assessed at baseline and after 6 weeks, 3 months, 6 months, and 1 year of follow-up. Data were analyzed using mixed models. Neither the patients nor the health-care providers were blinded.Results: Three hundred and eighty-six patients were randomized, and 326 of them were ultimately included in the analysis. The DASH scores were comparable between the usual-care group (n = 166) and the reduced-imaging group (n = 160) at all time points as well as overall. The adjusted regression coefficient for the DASH scores was 1.5 (95% confidence interval [CI] = -1.8 to 4.8). There was also no difference between the groups with respect to the overall PRWHE score (adjusted regression coefficient, 1.4 [95% CI = -2.4 to 5.2]), quality of life as measured with the EuroQol-5 Dimensions (EQ-5D) (-0.02 [95% CI = -0.05 to 0.01]), pain at rest as measured with a visual analog scale (VAS) (0.1 [95% CI = -0.2 to 0.5]), or pain when moving (0.3 [95% CI = -0.1 to 0.8]). The complication rate was similar in the reduced imaging group (11.3%) and the usual-care group (11.4%). Fewer radiographs were made for the participants in the reduced-imaging group (median, 3 versus 4; p < 0.05).Conclusions: This study shows that omitting routine radiography after the initial 2 weeks of follow-up for patients with a distal radial fracture does not affect patient-reported outcomes or the risk of complications compared with usual care.

• All authors: Gerven, P. van; Moumni, M. el; Zuidema, W.P.; Rubinstein, S.M.; Krijnen, P.; Tulder, M.W. van; Schipper, I.B.; Termaat, M.F.; Bodegom-Vos, L. van; Breederveld, R.S.; Derksen, R.J.; Dijkman, B. van; Goslings, J.C.; Hegeman, J.H.; Hoogendoorn, J.M.; Kuijk, C. van; Meylaerts, S.A.G.; Rosendaal, F.R.; Weil, N.L.; Wendt, K.W.; Warrior-Trial Study Grp
• Date: 2019-08-07
• Journal: Journal of Bone and Joint Surgery
• Volume: 101
• Issue: 15
• Pages: 1342 - 1350
• DOI: doi:10.2106/JBJS.18.01160