Scientific Articles   |    
Post-Splinting Radiographs of Minimally Displaced Fractures: Good Medicine or Medicolegal Protection?
Sonia Chaudhry, MD1; Edward M. DelSole, BS1; Kenneth A. Egol, MD1
1 NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1402, New York, NY 10003. E-mail address for S. Chaudhry: chaudhry85@gmail.com
View Disclosures and Other Information
  • Disclosure statement for author(s): PDF

Investigation performed at NYU Hospital for Joint Diseases, New York, NY, and Jamaica Hospital Medical Center, Jamaica, New York

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Sep 05;94(17):e128 1-5. doi: 10.2106/JBJS.K.00944
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case



Many institutions perform radiographic documentation following splint application even when no manipulation had been performed. The purpose of this study was to evaluate the utility of post-splinting radiographs of acute non-displaced or minimally displaced fractures that did not undergo manipulation. Our hypothesis was that post-splinting radiographs do not demonstrate changes in fracture alignment or impact the management of the patient.


After institutional review board exemption had been granted, consultations performed by orthopaedic residents at a level-I trauma center from September 2008 to April 2010 were reviewed. Of 2862 consultations, 1321 involved acute fractures that were splinted. Radiographs revealed that 342 (25.9%) of the fractures were non-displaced or minimally displaced and angulated (defined as <5 mm and <10°, respectively) and 204 of them had been assessed with radiographs after splinting. Consults were reviewed to ensure that the patients had not undergone manipulation prior to or during splinting. Consult notes and radiographs obtained in the emergency room (ER), as well as follow-up radiographs, were reviewed to assess ultimate outcome.


None of the 204 fractures (134 non-displaced and seventy minimally displaced) changed alignment following splinting. Two splints were reapplied, and the fractures sites were reimaged for undocumented reasons. Patients were subjected to an average of ten radiographs (range, four to twenty-five radiographs) of their extremities in the acute setting. On average, three post-splinting radiographs (range, one to ten radiographs) were obtained. The mean time between the initial and post-splinting radiographs was three hours and thirty minutes (range, nine minutes to twenty-four hours). The most common injury was a fracture about the hand or wrist. The 122 patients with that type of injury waited an average of almost three hours for an average of three post-splinting radiographs, contributing to a total of nine radiographs performed acutely. ER visits tended to be longer for patients with post-splinting radiographs compared with those without them (p = 0.06). Follow-up radiographs were available for eighty-two patients. All fractures demonstrated maintained alignment.


Post-splinting radiographs of non-displaced and minimally displaced fractures that do not undergo manipulation before or during immobilization are associated with longer ER waits, additional radiation exposure, and increased health-care costs without providing helpful information. While certain circumstances call for additional imaging, routine performance of post-splinting radiography of non-displaced or minimally displaced fractures should be discouraged.

Level of Evidence: 

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Results provided by:
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    PA - Penn State Milton S. Hershey Medical Center
    DC - Children's National Medical Center