Date of Award

January 2022

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Erica Herzog

Abstract

Abstract:Introduction: There are no commonly used guidelines for when to obtain postoperative radiographs following intramedullary nail (IMN) fixation after tibial shaft fractures. The current study assesses the utility of serial postoperative radiographs following IMN fixation of closed tibial shaft fractures of AO/OTA Types 42A (simple), and 42B (wedge).

Methods: Consecutive patients with closed extraarticular AO/OTA 42A and 42B tibial shaft fractures with two or more sets of postoperative radiographs were identified from a single academic level 1 trauma center. Radiographic sets and medical records were retrospectively reviewed for all included patients.

Results: Upon application of inclusion / exclusion criteria, 84 patients were identified. On average, these patients had 4.79 postoperative sets of radiographs (range = 2-9). For all postoperative radiographs, coronal and sagittal fracture alignment were within 5 degrees of the initial postoperative images. There were no identified losses of fixation or hardware failure. Five patients underwent subsequent surgery exclusively for removal of proximal interlocks causing pain. At the last available radiographic imaging set, the average RUST score was 10.16. Moreover, 42% of patients underwent imaging at an average of 463 days postoperatively with a fully healed RUST score of 12.

Conclusion: In extraarticular AO/OTA 42A and 42B fractures, routine imaging after the initial postoperative film set did not change clinical management. Interventions were only required for treatment of proximal interlock discomfort; moreover, such interventions were guided by clinical symptoms. In an era of cost containment and radiation mindfulness, the clinical practice of obtaining routine radiographs for patients with the above-noted injuries is questioned.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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