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Broken ankle xray6/22/2023 ![]() Treatment of fractures consists of either immobilization or surgical fixation (18% of distal radius fractures and 35% of ankle fractures). These are the most common fractures encountered, accounting for about 18% and 10% of all fractures, respectively. In the adult population, the incidence of fractures to the wrist (distal radius) and ankle (malleolar fractures) in the Netherlands is about 20,000 and 15,000 per year, respectively. Netherlands Trial Register NTR4610, registration date 22 June 2014.Įxtremity fractures are a common and costly healthcare problem affecting all age groups. This study will provide data on (cost) effectiveness of routine radiography in the follow-up of wrist and ankle fractures, and could pave the way for a change in (inter)national protocols. Both groups will be monitored at 1, 2, and 6 weeks and 3, 6, and 12 months. Secondary outcomes include: healthcare cost, the specific function measured with the Patient Rated Wrist and Hand Evaluation for wrist fractures and American Academy of Orthopaedic Surgeons foot and ankle questionnaire for ankle fractures, pain-intensity, health-related quality of life, self-perceived recovery, and complications. For wrist fractures, this includes the Disabilities of the Arm, Shoulder and Hand Score for the ankle fractures, this includes the Olerud and Molander ankle score. The primary outcome is the overall extremity-specific function. Patients will be randomized into two groups: Group 1 receives usual care, consisting of radiographs 1, 2, 6 and 12 weeks post-trauma Group 2 receives radiographs beyond the initial follow-up only when clinically indicated. In a multicenter randomized controlled trial, 697 patients aged 18 years or older will be included: 385 wrist fracture- and 312 ankle fracture patients. The aim of this study is to determine whether a modification of the radiographic follow-up protocol can be conducted with no worse outcome and less cost than the current standard of care for patients with a wrist or ankle fracture. However, it is questionable whether routine radiography following the initial follow-up ( 2-weeks post-trauma) is cost effective. Current protocols describe imaging at 1, 2, 6 and 12 weeks post-trauma. After this period, routine radiographs are scheduled for monitoring the bone-healing process. ![]() ![]() Loss of congruity or displacement leading to uneven joint loading, osteoarthritis and an increased probability of a poor functional outcome should be identified within the first 2 weeks post-trauma, based upon radiographs to determine optimal treatment. The management of these fractures depends on fracture type and loss of congruity of the joint, resulting in cast immobilization or operative treatment. Extremity fractures such as wrist and ankle fractures are a common and costly healthcare problem.
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