SRS26 - All or nothing? What is the optimal timing and frequency for post-operative radiographs in proximal phalanx fracture management?

Abstract Background Efficient recovery from closed proximal phalangeal fractures of the hand is critical to restoring function and enabling early return to work. Radiographs are essential for initial diagnosis and treatment planning, but clinical guidelines lack clear recommendations regarding the optimal timing of post-treatment imaging. This systematic review aims to evaluate current evidence on the timing of follow-up radiographs after conservative management of closed proximal phalangeal fractures. Methods A systematic review was conducted following PRISMA guidelines to identify studies addressing post-treatment radiograph timing in closed proximal phalangeal fractures without soft tissue injury. Electronic databases were searched using relevant MeSH terms. Due to a lack of randomized controlled trials, the search was expanded to include broader literature on timing of radiographic follow-up in patients undergoing conservative management for closed proximal phalanx fractures. Results From an initial pool of 427 articles, 14 articles were reviewed after exclusion criteria were applied. No consensus was identified regarding optimal timing for follow-up radiographs. Nor was any high-level evidence for a specific regimen identified. Some experts suggest that post-treatment radiographs may be unnecessary for certain fracture patterns. Conclusions There remains considerable variability in expert opinion regarding the necessity and timing of radiographic follow-up for closed stable proximal phalanx fractures. Defining clear criteria and standardised imaging protocols through further research is essential to optimise patient care, reduce unnecessary investigations, and facilitate timely return to function.