Early routine radiographic follow-up at 2-3 weeks for operatively treated tibia, fibula or ankle fractures does not contribute to identification of complications: A two center case series of 628 patients

Derek van Duuren; Robert K Wagner; Jacob S Borgida; Maaz Muhammad; Carlos R Sierra-Arce; Austin T Gregg; Adam N Musick; Derek S Stenquist; Mitchel B Harris; Thuan V Ly; Arun Aneja

doi:10.1016/j.injury.2025.112522

Early routine radiographic follow-up at 2-3 weeks for operatively treated tibia, fibula or ankle fractures does not contribute to identification of complications: A two center case series of 628 patients

Injury. 2025 Jun 18;56(8):112522. doi: 10.1016/j.injury.2025.112522. Online ahead of print.

Affiliations

¹ Harvard Medical School Orthopedic Trauma Initiative, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA; Leiden University Medical Center, 2333 ZA Leiden, The Netherlands. Electronic address: derekvanduuren@gmail.com.
² Harvard Medical School Orthopedic Trauma Initiative, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA; Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands.
³ Harvard Medical School Orthopedic Trauma Initiative, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.

PMID: 40554111
DOI: 10.1016/j.injury.2025.112522

Abstract

Objectives: To determine (1) if early routine radiographic follow-up at 2-3 weeks for patients with operatively treated tibia, fibula or ankle fractures identified complications (i.e., complications only visible on radiographs and not associated with symptoms on history taking or clinical examination) and (2) if these complications were clinically relevant (i.e., led to treatment change).

Methods: All adult patients who underwent operative treatment for a tibia, fibula or ankle fracture between January 2021 and January 2023 and who received early routine radiographic follow-up between 10 and 30 days postoperatively were included in this retrospective case series. Routine radiographs were defined as radiographs that were scheduled and obtained as part of the institution's standardized follow-up protocol. The primary outcome was the rate of complications detected on early routine radiographs, stratified by the presence of associated symptoms based on history taking or findings on physical examination. The secondary outcome was any documented treatment change for complications.

Results: Six hundred and twenty-eight patients (median age of 47 years, 42 % male) were included. A total of 5 complications in 628 patients (0.8 %) were seen on early routine radiographs, of which 3 complications (0.5 %) were exclusively identified on radiographs (i.e., not associated with symptoms). None of these 3 complications led to a change in treatment strategy. The remaining 2 complications were visible on radiographs but were accompanied by symptoms on history taking or physical examination.

Conclusion: The results of the current study suggest that radiographs at 2-3 weeks following operative treatment of tibia, fibula or ankle fractures may not need to be ordered routinely. Obtaining radiographs should be guided by clinical indication or by patient and surgeon preference (e.g., for reasons beyond complications). These findings should be considered in light of increasing healthcare expenditures and the time investment required of patients and healthcare professionals.

Keywords: Clinical decision-making; Complications; Cost-effectiveness; Follow-up; Fractures; Healthcare costs; Lower extremity; Orthopaedic trauma; Radiograph; Treatment change.