Comparison of the Safety and Cost of a Simplified Post-Operative Radiograph (SPOR) Protocol

Definitive Study for Non-inferiority Randomized Control Trial Comparing the Safety and Cost of a Simplified Post-Operative Radiographic (SPOR) Protocol for Selected Fractures

The standard post-operative radiographic protocol for the monitoring of fractures at Health Sciences Centre includes post-operative in hospital radiographs as well as radiographs at the two week follow up appointment. This is in addition to good quality intra-operative radiographs. With current operative techniques and implants, orthopaedic surgeons can achieve reliably stable internal fixation. In fact, patients are often allowed to take weight through the fractured limb immediately post-operatively. In these cases, redundant post-operative radiographs likely represent an avoidable cost to the system financially, and an avoidable cost to the patient in additional time spent in hospital and unnecessary radiation exposure.

Inclusion Criteria:

• At least one lag screw for each fracture line
• At least one compression plate across each fracture line
• Locked intramedullary nail
• Articular/peri-articular fracture with antiglide/under-contoured plate
• Tension band technique (plate included) in simple fracture pattern
• Operating surgeon is confident in fixation construct, despite non-load sharing criteria.

Exclusion Criteria:

• Fracture >21 days old
• Age <18 years, or open growth plates
• Articular fracture with depression
• Multiple orthopaedic fractures
• History or radiographic appearance of osteoporosis/osteopenia or poor operative bone quality
• Likely difficulty with follow-up in first 6 weeks