Postoperative Radiography Protocol Following Closed Reduction and Internal Fixation of a Pertrochanteric Femur Fracture: Self Assesment and Reccomendations

Introduction: There is no consensus regarding the proper radiographic protocol following closed reduction and internal fixation of intertrochanteric femural fractures. Despite its’ questionable necessity and significant economic burden, many medical centers including ours practice a policy of imaging internally fixated proximal femurs after the patients bear weight on them. Our goal was to assess the added value of the postoperative imaging study described.

Materials and Methods: We conducted a prospective study. All patients who were treated with closed reduction and internal fixation of AO31A fractures were enrolled. Two sets of imaging studies were assessed- the intraoperative AP and axial fluoroscopy studies and the radiograms that were taken following bearing weight on the operated hip. Three decision making steps took place regarding weight bearing limitations and a necessity for reoperation- (1) Immediately after the operation; (2) A day after the operation; (3) Following weight bearing according to a new radiogram. Objective measurements were taken for each hip on both imaging modalities.

Results: 60 patients were operated and evaluated as described above, 17 males and 43 females. The mean patients’ age was 82. The fractures distributed according to AO classification as follow: 14 cases of 31A1; 39 cases of 31A2; 7 cases of 31A3. There was no need to change the weight bearing recommendation following the radiogram assessment in all patients who took part in this study.

Conclusions: there is no added value for routine post-operative radiograms within the first days following closed reduction and internal fixation of intertrochanteric femural fractures.