Routine post-operative radiographs following orif of mandibular fractures: clinical need or unnecessary radiation?

Background and objectives : Post-operative radiographs are conventionally taken following open reduction and internal fixation (ORIF) of mandibular fractures in order to assess the adequacy of reduction and fixation. We aimed to investigate the influence of radiographs on immediate post-operative management and their usefulness in predicting complications.

Methods : Radiographs and casenotes were retrospectively reviewed for 117 consecutive patients treated with ORIF for mandibular fractures at the University Hospital of Wales. Radiographs were evaluated by three independent assessors in terms of adequacy of reduction and fixation using locally agreed criteria. These were correlated with short- and long-term outcomes as recorded in the casenotes.

Results : A total of 9 patients required a return to theatre; 5 of these were for removal of an infected plate and 3 required repeat ORIF. All of these patients had clinical signs and symptoms and their post-operative radiographic appearance had been satisfactory. Of the cases with a poor post-operative radiographic appearance, none developed complications/returned to theatre.

Conclusions : Routine post-operative radiographs following ORIF of mandibular fractures appear to be of little value in the management of patients without clinical signs of inadequate reduction or fixation. The decision to re-operate is based on clinical signs rather than radiographic appearance and radiographs do not seem to be predictive of long-term outcomes. In view of their radiation risk and cost implications, we advocate radiographs only in those cases where there is a clear clinical indication and that the practice of taking routine “check” radiographs should be discontinued.

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Jan 20, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Routine post-operative radiographs following orif of mandibular fractures: clinical need or unnecessary radiation?
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