The cores of operative treatment for DRFs include keeping reduction and strong fixation[4, 13].Orthopedic surgeons always evaluate the reduction and healing progress of the fracture in the light of postoperative imaging.However, more and more investigators question the significance of early postoperative imaging because this not only may increase the cost of medical management and radiation dose,but also can’t display fracture healing progress early. The purpose of this study is to evaluate the worth of routine postoperative radiographs for patients following VLP through a retrospective analysis of patients.
As far as we know, This is the first study assessing postoperative visit x-rays for patients treated with volar locking plates in China.In this study, the effect of early radiographs after VLP was evaluated with a retrospective analysis of 213 patients. We committed to revealing whether early routine plain films will change clinical treatment strategies. In our sample, 179 patients had routine early radiographs after their operation, of which 2 (1.1%) had their clinical management altered. The fracture type of all 2 were consistent with AO C3 fractures, which have the highest risk of complications due to their complexity. These results suggest that early postoperative radiographs offer little clinical information in the assessment and management of operatively fixed DRFs with a volar locking plate, particularly in the extra-articular. In other words, early postoperative radiographs rarely change the postoperative clinical management of patients.
At the same time, we also noticed 94% of patients had extra-articular fractures among patients who did not undergo early imaging,it may be bacause they were told that their fracture is not serious by surgeons in the first visiting.
Our results are consistent with the findings of prior studies. Chaudhry et al. demonstrated that serial radiographs in acute settings do not alter fracture management in minimally displaced fractures. Besides, Teo et al. reported that current literature suggested immediate postoperative radiography can’t result in management change in the great majority of patients after orthopedic surgery. Added profound reporting and further prospective comparative research should be encouraged. Furthermore, Johnson et al. showed that 96% of patients did not undergo further treatment after early plain films. Based on their study, this may provide a basis for reducing early postoperative imaging examinations.Weil et al. demonstrated only 1.5% of routine radiographs affect post-operative management after VLP for DRFs, high medical costs associated should be weighed, many radiographs are taken on routine without altered clinical decision-making and can be removed. Schultz et al.  found early postoperative radiographs had no obvious effect on patient satisfaction, but it may play an important role in the surgeon’s explanation of their injury.
These studies concluded that early routine radiographs did not significantly influence clinical decision making, but did increase health care costs and radiation exposure. our study performs all 2 patients who had AO type C fractures(AO/OTA classification)were altered treatment,it mays be related to AO type C fractures resulted in the highest risk of complications.Although current research shows that early postoperative examination is of little significance, we consider it is not advisable to arbitrarily reduce early postoperative inspections.We believe that decisions should be made on a case-by-case basis based on the individual risk of each patient.This emphasizes the importance of risk stratification, and routine early postoperative X-ray examinations for some patients with DRFs. By the current results, DRFs patients with type C (AO/OTA classification) need more early postoperative radiographs.
There are some limitations in our research. First of all, we neither introduced a functional rating scale to evaluate the postoperative situation nor did we investigate patient satisfaction, whether to undergo revision surgery may not be enough to explain the problem. Secondly, this study is retrospective and may limit the interpretation of data, a prospective study could easily be developed to increase the numbers and reliability of the data. At last, The small sample size may make it difficult to obtain reliable conclusions.