Intra-operative fluoroscopic screening is common practice in trauma surgery, as an operative guide and to assess the final fixation. However, often patients return to the ward and are sent for a further ‘check x-ray’ in the subsequent post-operative period.

Our aims were to evaluate the use of post-op ‘check x-rays’ in our hospital, and determine whether they had any influence on the management or outcomes for our trauma patients. Between December 2010 and June 2011, our study population included all patients who had intra-operative fluoroscopic images for trauma fixation surgery at Grantham and District Hospital. We then reviewed whether they had an additional x-ray taken in the post-operative period. Finally we assessed their subsequent fracture clinic follow-up images to determine whether there were any complications that had arisen. There were 108 patients who had intra-operative films, with a mean age of 59.7 years (17 to 98). Of these, 44% of patients had an additional x-ray in the post-operative period. There was a wide variability in practice between the various types of fixations (e.g. Hip, Humerus, Ankle, etc). At follow-up, all x-rays were satisfactory and there were no complications. The post-operative x-ray did not alter the management or outcome for any of our patients. There is no need for a ‘routine post-op check x-ray’ for patients who have had an adequate intra-operative film. Subjecting patients to additional x-rays causes them discomfort, delayed discharged, increased radiation exposure and has significant financial implications. Other similar studies support our results, and a post-operative film should only be requested if clinically indicated or in exceptional circumstances.

Distal radius fractures are very common and they often require surgical intervention to prevent long-term complications. We noticed that several patients were being managed non-operatively for prolonged periods of time, when ultimately surgical fixation was inevitable. Delayed fixation of these injuries results in prolonged immobilisation, repeat fracture clinic attendances, callous formation, poor soft tissues, stiffness and union. Our aim was to analyse the time to fixation of distal radius fractures at our hospital using a standard volar locking plate. Between December 2010 and September 2011, our study population included all patients who underwent surgical fixation for a distal radius fracture at Royal Derby Hospital. All fractures were fixed using a volar locking plate. Data collected included date of injury, fracture clinic attendances, date listed for surgery and date of surgery. There were 100 patients who underwent surgical fixation, with a mean age of 63.6 years (17 to 91). The mean date from injury to fixation was 7.7 days (range 0 to 23). 82% of fractures were operated on within 14 days, and 98% were fixed within 21 days. We accept that our study does have some limitations; this includes patients who are unwilling to accept surgery at their initial consultation. Distal radius fractures have a strong tendency to revert back to their original configuration; hence we suggest that a decision to operate should ideally be made at the one-week fracture clinic appointment. This avoids the difficulties and complications associated with delayed surgical intervention. Stability, displacement, reduction and patient factors should all be taken into account.