Second physician review of radiographs after wrist and ankle reductions offers limited utility to clinical management

• Published in: Emergency radiology Vol. 27; no. 2; pp. 191 - 193
• Main Authors: Christiano, Anthony V., Cirino, Carl M., Elsevier, Hannah C. K., Podolnick, Jeremy D., Forsh, David A.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.04.2020; Springer Nature B.V
• Subjects: Acceptability; Ankle; Ankle Injuries - diagnostic imaging; Ankle Injuries - surgery; Clinical Competence; Emergency Medicine; Emergency Service, Hospital; Female; Fractures; Humans; Imaging; Male; Medicine; Medicine & Public Health; Original Article; Outcome Assessment, Health Care; Physicians; Postoperative Period; Radiographs; Radiology; Radius Fractures - diagnostic imaging; Radius Fractures - surgery; Reduction; Referral and Consultation; Wrist; Post-reduction; Second physician review; Ankle fracture; Distal radius fracture
• ISSN: 1070-3004; 1438-1435
• DOI: 10.1007/s10140-019-01746-4

Purpose The purpose of this study is to determine the clinical utility of second-physician review of radiographs obtained after reduction of distal radius and ankle fractures. Methods Fifty consecutive ankle and distal radius fractures requiring reduction were reviewed. The time from post-reduction radiograph to second-physician interpretation was obtained. The second-physicians’ interpretation was evaluated for clinically influential information. Patients requiring a repeat reduction were identified, and the timing of the repeat reduction radiograph was compared with the timing of the second-physician interpretation of the initial post-reduction radiograph. Results The mean time of second-physician interpretation for post reduction ankle radiographs was 6 h and 47 min (range 4 min to 43 h and 3 min). Eleven of 50 (22%) interpretations of post reduction ankle radiographs commented on acceptability of reduction. The mean time of second-physician interpretation for post reduction distal radius radiographs was 5 h and 34 min (range 8 min to 22 h and 59 min). Seven of 50 (14%) interpretations of post reduction distal radius radiographs commented on acceptability of reduction. Three distal radius (6%) and 8 ankle fractures (16%) required repeat reduction. Repeat reductions were completed in 10/11 cases (91%) before the second-physician review of the initial post reduction radiograph was obtained. In only 1 case of repeat reduction was the second-physician review of the post reduction radiograph available before repeat reduction was attempted. Conclusion The timing and quality of second-physician review of post-reduction radiographs offers little utility to the clinical management of ankle and distal radius fractures.