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Original article
peer-reviewed

Ultrasound-Assisted Distal Radius Fracture Reduction



Abstract

Introduction

Closed reduction of distal radius fractures (CRDRF) is a commonly performed emergency department (ED) procedure. The use of point-of-care ultrasound (PoCUS) to diagnose fractures and guide reduction has previously been described. The primary objective of this study was to determine if the addition of PoCUS to CRDRF changed the perception of successful initial reduction. This was measured by the rate of further reduction attempts based on PoCUS following the initial clinical determination of achievement of best possible reduction.

Methods 

We performed a multicenter prospective cohort study, using a convenience sample of adult ED patients presenting with a distal radius fracture to five Canadian EDs. All study physicians underwent standardized PoCUS training for fractures. Standard clinically-guided best possible fracture reduction was initially performed. PoCUS was then used to assess the reduction adequacy. Repeat reduction was performed if deemed indicated. A post-reduction radiograph was then performed. Clinician impression of reduction adequacy was scored on a 5 point Likert scale following the initial clinically-guided reduction and following each PoCUS scan and the post-reduction radiograph.

Results 

There were 131 patients with 132 distal radius fractures. Twelve cases were excluded prior to analysis. There was no significant difference in the assessment of the initial reduction status by PoCUS as compared to the clinical exam (mean score: 3.8 vs. 3.9; p = 0.370; OR 0.89; 95% CI 0.46 to 1.72; p = 0.87). Significantly fewer cases fell into the uncertain category with PoCUS than with clinical assessment (2 vs 12; p = 0.008). Repeat reduction was performed in 49 patients (41.2%). Repeat reduction led to a significant improvement (p < 0.001) in the PoCUS determined adequacy of reduction (mean score: 4.3 vs 3.1; p < 0.001). In this group, the odds ratio for adequate vs. uncertain or inadequate reduction assessment using PoCUS was 12.5 (95% CI 3.42 to 45.7; p < 0.0001). There was no significant difference in the assessment of reduction by PoCUS vs. radiograph.

Conclusions

PoCUS-guided fracture reduction leads to repeat reduction attempts in approximately 40% of cases and enhances certainty regarding reduction adequacy when the clinical assessment is unclear.



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Original article
peer-reviewed

Ultrasound-Assisted Distal Radius Fracture Reduction


Author Information

Steve Socransky

Emergency Medicine, Northern Ontario School of Medicine

Andrew Skinner

Emergency Medicine, University of British Columbia Vancouver

Mark Bromley

Emergency Medicine, University of Calgary

Andrew Smith

Emergency Medicine, Memorial University of Newfoundland

Alexandre Anawati

Emergency Medicine, Northern Ontario School of Medicine

Jeff Middaugh

Emergency Medicine, Northern Ontario School of Medicine

Peter Ross

Emergency Medicine, Saint John Regional Hospital / Dalhousie University

Paul Atkinson Corresponding Author

Emergency Medicine, Saint John Regional Hospital

Emergency Medicine, Dalhousie University


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Horizon Health Network issued approval HHN 2011-1666. Research Ethics Board approval was obtained from the following institutions: St. Paul’s Hospital (Vancouver, British Columbia), Foothills Medical Centre (Calgary, Alberta), Health Sciences North (Sudbury, Ontario), Saint John Regional Hospital (Horizon Health Network, Saint John, New Brunswick), Health Sciences Centre (St. John’s, Newfoundland & Labrador). Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

Acknowledgements

The authors wish to thank all the physicians who enrolled patients in the study as well as Vic Sahai and Larry Stitt for their excellent statistical support and David Lewis for images.


Original article
peer-reviewed

Ultrasound-Assisted Distal Radius Fracture Reduction


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Original article
peer-reviewed

Ultrasound-Assisted Distal Radius Fracture Reduction

  • Author Information
    Steve Socransky

    Emergency Medicine, Northern Ontario School of Medicine

    Andrew Skinner

    Emergency Medicine, University of British Columbia Vancouver

    Mark Bromley

    Emergency Medicine, University of Calgary

    Andrew Smith

    Emergency Medicine, Memorial University of Newfoundland

    Alexandre Anawati

    Emergency Medicine, Northern Ontario School of Medicine

    Jeff Middaugh

    Emergency Medicine, Northern Ontario School of Medicine

    Peter Ross

    Emergency Medicine, Saint John Regional Hospital / Dalhousie University

    Paul Atkinson Corresponding Author

    Emergency Medicine, Saint John Regional Hospital

    Emergency Medicine, Dalhousie University


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Horizon Health Network issued approval HHN 2011-1666. Research Ethics Board approval was obtained from the following institutions: St. Paul’s Hospital (Vancouver, British Columbia), Foothills Medical Centre (Calgary, Alberta), Health Sciences North (Sudbury, Ontario), Saint John Regional Hospital (Horizon Health Network, Saint John, New Brunswick), Health Sciences Centre (St. John’s, Newfoundland & Labrador). Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements

    The authors wish to thank all the physicians who enrolled patients in the study as well as Vic Sahai and Larry Stitt for their excellent statistical support and David Lewis for images.


    Article Information

    Published: July 07, 2016

    DOI

    10.7759/cureus.674

    Cite this article as:

    Socransky S, Skinner A, Bromley M, et al. (July 07, 2016) Ultrasound-Assisted Distal Radius Fracture Reduction. Cureus 8(7): e674. doi:10.7759/cureus.674

    Publication history

    Received by Cureus: June 02, 2016
    Peer review began: June 04, 2016
    Peer review concluded: June 22, 2016
    Published: July 07, 2016

    Copyright

    © Copyright 2016
    Socransky et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction

Closed reduction of distal radius fractures (CRDRF) is a commonly performed emergency department (ED) procedure. The use of point-of-care ultrasound (PoCUS) to diagnose fractures and guide reduction has previously been described. The primary objective of this study was to determine if the addition of PoCUS to CRDRF changed the perception of successful initial reduction. This was measured by the rate of further reduction attempts based on PoCUS following the initial clinical determination of achievement of best possible reduction.

Methods 

We performed a multicenter prospective cohort study, using a convenience sample of adult ED patients presenting with a distal radius fracture to five Canadian EDs. All study physicians underwent standardized PoCUS training for fractures. Standard clinically-guided best possible fracture reduction was initially performed. PoCUS was then used to assess the reduction adequacy. Repeat reduction was performed if deemed indicated. A post-reduction radiograph was then performed. Clinician impression of reduction adequacy was scored on a 5 point Likert scale following the initial clinically-guided reduction and following each PoCUS scan and the post-reduction radiograph.

Results 

There were 131 patients with 132 distal radius fractures. Twelve cases were excluded prior to analysis. There was no significant difference in the assessment of the initial reduction status by PoCUS as compared to the clinical exam (mean score: 3.8 vs. 3.9; p = 0.370; OR 0.89; 95% CI 0.46 to 1.72; p = 0.87). Significantly fewer cases fell into the uncertain category with PoCUS than with clinical assessment (2 vs 12; p = 0.008). Repeat reduction was performed in 49 patients (41.2%). Repeat reduction led to a significant improvement (p < 0.001) in the PoCUS determined adequacy of reduction (mean score: 4.3 vs 3.1; p < 0.001). In this group, the odds ratio for adequate vs. uncertain or inadequate reduction assessment using PoCUS was 12.5 (95% CI 3.42 to 45.7; p < 0.0001). There was no significant difference in the assessment of reduction by PoCUS vs. radiograph.

Conclusions

PoCUS-guided fracture reduction leads to repeat reduction attempts in approximately 40% of cases and enhances certainty regarding reduction adequacy when the clinical assessment is unclear.



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Steve Socransky

Emergency Medicine, Northern Ontario School of Medicine

Andrew Skinner

Emergency Medicine, University of British Columbia Vancouver

Mark Bromley

Emergency Medicine, University of Calgary

Andrew Smith

Emergency Medicine, Memorial University of Newfoundland

Alexandre Anawati

Emergency Medicine, Northern Ontario School of Medicine

Jeff Middaugh

Emergency Medicine, Northern Ontario School of Medicine

Peter Ross

Emergency Medicine, Saint John Regional Hospital / Dalhousie University

Paul Atkinson, Professor

Emergency Medicine, Saint John Regional Hospital

For correspondence:
paul.atkinson@dal.ca

Steve Socransky

Emergency Medicine, Northern Ontario School of Medicine

Andrew Skinner

Emergency Medicine, University of British Columbia Vancouver

Mark Bromley

Emergency Medicine, University of Calgary

Andrew Smith

Emergency Medicine, Memorial University of Newfoundland

Alexandre Anawati

Emergency Medicine, Northern Ontario School of Medicine

Jeff Middaugh

Emergency Medicine, Northern Ontario School of Medicine

Peter Ross

Emergency Medicine, Saint John Regional Hospital / Dalhousie University

Paul Atkinson, Professor

Emergency Medicine, Saint John Regional Hospital

For correspondence:
paul.atkinson@dal.ca