ArticleJournal of hand surgery global online2025
The Rate and Utility of Follow-Up Radiographs for Nonoperatively Treated Isolated Radial Head Fractures.
Article in Journal of hand surgery global online, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: Prior literature has shown that although follow-up radiographs are obtained for approximately two-thirds of nonoperatively treated isolated radial head fractures, they generally do not change management. This study aims to investigate the current practice regarding follow-up radiographs for these injuries and the utility of obtaining these studies. Methods: A retrospective review was performed of patients with isolated radial head fractures initially treated nonoperatively at two Level I trauma centers between 2016 and 2020. Patient details, treatment course, and radiographic measurements were recorded. The primary outcome was the acquisition of follow-up radiographs. Secondary outcomes included the number of follow-up radiographs, interval fracture displacement, planned versus unplanned clinic appointments, radiographic union on final follow-up films, change in management based on follow-up radiographs, and nonunion and/or conversion to surgery. Bivariate statistical analysis was performed. Results: Of 318 patients with 322 isolated radial head fractures initially treated nonoperatively (92% Mason I, 8% Mason II), 217 (67%) had 331 total sets of follow-up radiographs, with a median of 1 set per fracture. Increased articular displacement and Mason II classification were associated with increased number of follow-up radiographs. No patient had a change in management based on follow-up radiographs or documentation of nonunion or conversion to surgery. Median interval fracture displacement was 0 mm. The rate of follow-up radiographs was 11% higher among patients with unplanned clinic visits. Conclusions: The incidence of follow-up radiographs for nonoperatively treated isolated radial head fractures has remained similar compared to previous reports, despite prior evidence demonstrating a lack of utility. In our cohort, follow-up radiographs did not change management and interval displacement was minimal, even among patients with unplanned clinic visits. Follow-up radiographs in this clinical scenario are a low-value test, and providers should reconsider the utility of obtaining these studies. Type of study/level of evidence: Therapeutic IV.
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