LIMITED RECOMMENDATION No high-quality studies were identified to address this question. One moderate quality study (van Gerven, P., 2019) was identified. This multicenter, prospective, randomized, controlled trial was specifically designed to evaluate the impact of eliminating routine radiographs after the two-week follow up for distal radius fracture. Control group patients received x-rays of the wrist at 1,2,6, and 12 weeks post injury. The experimental group received x-rays of the wrist at 1 and 2 weeks. Thereafter they received wrist x-rays only if they experienced a new trauma, a spike in their pain, or a worsening of their neuro-vascular condition. Patients were followed for 52 weeks. At no time during the 52-week study were there statistically significant differences between the two groups in patient reported measures, (DASH, PRWHE), quality of life, (EQ5), or pain, (VAS). At 52 weeks there were minimally statistically significant differences in range of motion favoring the more frequent x-ray group. Total flexion/extension arc was 10 degrees better, (123 vs 113), and pronation/supination was also better, (175 degrees vs 155 degrees). These differences appear not to impact patient reported outcomes. There was no difference in the complication rate. Patients in the control group received four sets of wrist radiographs. Patients in the experimental group received an average of three.
Risks and Benefits of Implementation
This recommendation is based on a PICO question which was specifically focused on acute management. The benefits of implementing this strategy of eliminating routine radiographs of distal radius fractures after the two-week follow up include reduced radiation to the patient and reduced cost to patient, payer, and society. In this study there was no increase in the complication rate. There may be some possible value in obtaining a final radiograph outside of the time frame addressed within this PICO to establish a healed baseline for comparison against future wrist pain.
Future Research
Longer term follow-up, (5 and 10 year) will be useful to determine if non-inferiority of the reduced radiograph group is maintained.