Reducing Exposure to X-Ray in Patients With Conservatively Managed Distal Radius Fractures: A Closed-Loop Pilot Audit

Cureus. 2022 Nov 27;14(11):e31929. doi: 10.7759/cureus.31929. eCollection 2022 Nov.


Introduction British Orthopaedic Association Standards for Trauma (BOAST) guidelines state that a radiograph of the wrist at the time of removal of immobilisation is not required in conservatively managed distal radius fracture (DRF) patients unless there is clinical cause for concern. The aim of this pilot audit was to investigate local compliance with these guidelines. Materials and methods The first cycle of a retrospective audit was performed on conservatively managed DRF patients presenting between August and October 2021. An intervention was introduced in the form of education to highlight current guidelines. A second cycle was then performed prospectively on patients presenting between February and April 2022. Data was analysed to assess whether radiographs were taken at the time of cast removal, if the indication for the radiograph was documented and whether it affected the management plan. Results In the first cycle, 20 of 46 patients (43.5%) had repeat radiographs at the time of cast removal compared to 12 of 41 patients (29.3%) in the second cycle (p=0.170). None of the first-cycle patients had any documentation on the indication for radiograph at the time of cast removal and none of the radiographs altered the management plan. In the second cycle documentation on the indication for the radiograph was present for seven of the 12 radiographs and two altered the management plan. Conclusion Through education on adherence to national guidelines, the number of radiographs in patients with conservatively managed DRFs was reduced.

Keywords: conservative management; cost reduction; distal radius fractures; hand-wrist radiograph; radiation dose reduction; x-ray evaluation.