The Rate and Utility of Follow-Up Radiographs for Nonoperatively Treated Isolated Radial Head Fractures

Purpose: Prior literature has shown that although follow-up radiographs are obtained for approximately two-thirds of nonoperatively treated isolated radial head fractures, they generally do not change management. This study aims to investigate the current practice regarding follow-up radiographs for these injuries and the utility of obtaining these studies. Methods: A retrospective review was performed of patients with isolated radial head fractures initially treated nonoperatively at two Level I trauma centers between 2016 and 2020. Patient details, treatment course, and radiographic measurements were recorded. The primary outcome was the acquisition of follow-up radiographs. Secondary outcomes included the number of follow-up radiographs, interval fracture displacement, planned versus unplanned clinic appointments, radiographic union on final follow-up films, change in management based on follow-up radiographs, and nonunion and/or conversion to surgery. Bivariate statistical analysis was performed. Results: Of 318 patients with 322 isolated radial head fractures initially treated nonoperatively (92% Mason I, 8% Mason II), 217 (67%) had 331 total sets of follow-up radiographs, with a median of 1 set per fracture. Increased articular displacement and Mason II classification were associated with increased number of follow-up radiographs. No patient had a change in management based on follow-up radiographs or documentation of nonunion or conversion to surgery. Median interval fracture displacement was 0 mm. The rate of follow-up radiographs was 11% higher among patients with unplanned clinic visits. Conclusions: The incidence of follow-up radiographs for nonoperatively treated isolated radial head fractures has remained similar compared to previous reports, despite prior evidence demonstrating a lack of utility. In our cohort, follow-up radiographs did not change management and interval displacement was minimal, even among patients with unplanned clinic visits. Follow-up radiographs in this clinical scenario are a low-value test, and providers should reconsider the utility of obtaining these studies. Type of study/level of evidence: Therapeutic IV.