Ultrasound-Assisted Distal Radius Fracture Reduction.

Area of Science:

• Emergency Medicine
• Radiology
• Orthopedic Surgery

Background:

• Closed reduction of distal radius fractures (CRDRF) is a standard emergency department (ED) procedure.
• Point-of-care ultrasound (PoCUS) has been explored for diagnosing fractures and guiding reduction.
• The impact of PoCUS on the perceived success of initial CRDRF requires further investigation.

Purpose of the Study:

• To determine if incorporating PoCUS into CRDRF changes the perception of successful initial reduction.
• To assess if PoCUS influences the rate of further reduction attempts after initial clinical assessment.
• To compare clinician impression of reduction adequacy using clinical exam, PoCUS, and radiography.

Main Methods:

• A multicenter prospective cohort study involving adult ED patients with distal radius fractures.
• Physicians utilized standardized PoCUS training for fracture assessment and reduction guidance.
• Initial reduction was clinically guided, followed by PoCUS assessment, and repeat reduction if indicated, with post-reduction radiography.

Main Results:

• No significant difference was found in the initial reduction assessment between PoCUS and clinical exam (mean score 3.8 vs. 3.9).
• PoCUS significantly reduced the number of uncertain reduction assessments compared to clinical exam (2 vs. 12 cases).
• Repeat reductions, guided by PoCUS, led to significant improvements in reduction adequacy (mean score 4.3 vs. 3.1) and increased certainty.

Conclusions:

• PoCUS-guided fracture reduction prompts repeat attempts in approximately 40% of cases.
• PoCUS enhances certainty regarding reduction adequacy, particularly when clinical assessment is unclear.
• There was no significant difference in reduction assessment between PoCUS and post-reduction radiography.