The additional value of radiology reports in the follow-up of extremity fractures: a retrospective study in an academic hospital.

Background: Radiology reports on radiographic findings during follow-up (FU) after extremity fractures are generally not yet available when the patient is seen by the treating orthopedic trauma surgeon and may therefore be redundant. The aim of this study was to explore the inter-observer agreement on the reported findings of the FU radiograph between orthopedic trauma surgeons and radiologists. Method: This retrospective cohort study included all FU radiographs of adult patients with an extremity fracture, treated in a Dutch university hospital between January 2022 and July 2023. The radiologist's and orthopedic trauma surgeon's assessments of unacceptable alignment, delayed/non-union and abnormalities associated with osteosynthesis material (OSM) on the FU radiographs were collected from the medical files. Fracture healing was considered normal in the absence of these findings. The interobserver agreement of the radiographic parameters between surgeon and radiologist was determined using Cohens' Kappa (κ). Additionally, incidental findings and their clinical relevance were explored. Results: 953 FU radiographs of 569 patients were included. The interobserver agreement was close to perfect for normal fracture healing (κ = 0.82, 95 % CI 0.77-0.88) and delayed/non-union (κ = 0.94, 95 % CI 0.89-0.99). The inter-observer agreement was substantial for unacceptable alignment of the fracture (κ = 0.80, 95 % CI 0.72-0.88) and abnormalities associated with the OSM (κ = 0.77, 95 % CI 0.65-0.89). Twenty-one incidental findings were diagnosed in the FU by the radiologist of which two were also independently described by the surgeon. Three of the findings that were missed or not described by the surgeon could have clinical significance, however the missing of these findings did not lead complications or additional hospital visits. These included two missed rib fractures and one osteochondral defect, which led to prolonged immobilization due to pain. Conclusion: Radiographic reports in the FU of extremity fractures have limited additional value for clinical care and probably lacks cost-effectiveness or efficiency.