Increased Efficiency With Use of a Mini C-Arm in Emergency Department Closed Reductions

To determine whether use of a mini C-arm increased emergency department (ED) efficiency and decreased patient radiation exposure and the frequency of repeat closed reductions, as compared with traditional postreduction radiographs in patients with isolated distal radius and ankle fracture.

Retrospective chart review.

Academic Level 1 Trauma Center.

Adult patients with an isolated distal radius (OTA/AO 2R3A2), bimalleolar or trimalleolar ankle (OTA/AO 44B1) fractures requiring closed reduction by the orthopaedic surgery team in an academic level 1 trauma center ED from 2013 to 2023 were included. Patients with pathologic fractures were excluded.

Closed reductions in which mini C-arm imaging was used were compared with those that used traditional postreduction radiographs. Total radiation exposure to the patient during the encounter (mGy), closed reduction radiation exposure (mGy), the number of repeated reductions in the ED requiring an additional analgesic/anesthetic event and splint application, orthopaedic consult time, doctor visit to discharge time, and time under sedation (conscious or unconscious) were compared between the mini C-arm group and the traditional postreduction radiographs group.

A total of 199 subjects met inclusion criteria (81 ankle fractures and 118 distal radius fractures). For the mini C-arm group, the mean age was 59 years (range 25-93) and 58% of the patients were female (n = 14). For the traditional postreduction radiographs group, the mean age was 58 years (range 21-90) and 55% of the patients were female (n = 96). Use of a mini C-arm (16 ankle fractures and 8 distal radius fractures) versus traditional postreduction radiographs (65 ankle fractures and 110 distal radius fractures) resulted in significantly lower total radiation exposure, 0.9 mGy versus 0.4 mGy ( P < 0.001), and closed reduction radiation exposure, 0.5 versus 0.1 mGy ( P < 0.001); fewer repeated reductions, 65 versus 0 repeated reductions ( P < 0.001); and shorter time from doctor visit to discharge, 6.2 versus 3.8 hours ( P < 0.001), orthopaedic consult time, 4.0 versus 1.7 hours ( P < 0.001), and time under sedation, 37 versus 26 minutes ( P = 0.046).

This study found that the use of a mini C-arm compared with traditional postreduction radiographs for distal radius and ankle fracture closed reductions improved ED efficiency and decreased patient radiation exposure and repeated closed reductions.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.