Are routine radiographs during conservative treatment of fractures of the fourth and fifth metacarpals useful?

In two retrospective studies we investigated the additional information provided by follow-up radiographs during the conservative treatment of fractures of the fourth or fifth metacarpal. In the first study we evaluated the number of follow-up radiographs made and their actual influence on the treatment. In 307 consecutive cases, 0-9 (mean 1.93) follow-up radiographs were made. Two cases (0.6%) revealed additional information influencing the treatment policy. Based on physical examination, this alteration was already expected prior to taking the radiograph. In a complementary radiological study, in only one out of 466 (0.2%) follow-up radiographs of 288 selected conservatively treated fractures, relevant information would possibly have been missed, had follow-up radiography been selective only. Residual symptoms (subjectively diminished function, stiffness, pain or intolerance to cold) cannot be prevented by taking more radiographs. During the treatment of these fractures, follow-up radiographs are only indicated if physical examination suggests loss of reduction or instability within one week of the fracture.