Ankle fractures are extremely common orthopedic injuries that frequently require surgical fixation [1,2]. In the post-operative setting, these fractures are routinely monitored with history, physical examination, and regular radiographic surveillance [3]. The goal of post-operative imaging is to monitor for complications, including those that may require re-operation [4]. Among complications, fracture non-union and failure of fixation are of particular importance due to the significant patient morbidity and the cost of re-operation [5].

While follow-up X-rays in patients with operatively treated ankle fractures are the norm, the utility of these studies in asymptomatic patients has not been demonstrated [6]. Previous work looking at the utility of post-operative X-rays following distal radius fractures found that these studies are of low diagnostic yield and rarely change management [7,8]. The same is true for fractures of the tibia and femur treated with intramedullary rod fixation, as well as anteroposterior radiographs in patients treated with anterior cervical decompression and fusion [9,10]. Work by Friedman et al. has looked at the utility of X-rays in asymptomatic patients with healed ankle fractures and found that these studies rarely alter patient outcomes [11]. Work by van Gerven looked at the acute management period of both operative and non-operative ankle fractures and found that only about 1 % of radiographs resulted in changes in management [12]. However, there has been no study focusing on surveillance imaging prior to bony union in operatively treated ankle fractures. These studies have significant costs, both in the form of financial cost, as well as increased clinic waiting time and radiation exposure for patients [13].

This study sought to examine how frequently post-operative radiographs result in management changing decisions for operatively treated ankle fractures. We further sought to identify whether X-rays would be more or less likely to result in management changing decisions if they were conducted as screening studies in asymptomatic patients versus whether they were performed with some clinical correlation on history or physical examination. We hypothesized that surveillance radiographs in asymptomatic patients would not result in significant changes in management.