Distal radius fractures: interspecialty agreement on reduction adequacy following emergency department reduction

Distal radius fractures are among the most common fractures seen in the emergency department, and reduction of displaced fractures is resource-intensive. We evaluated radiographic adequacy of reductions performed in the emergency department, maintenance of reduction at follow-up, and agreement between orthopedic surgeons and radiologists.

This observational cohort study used a structured review of health records and radiographs. Patients undergoing procedural sedation and closed reduction of a distal radius fracture were included. Radiographs obtained at initial assessment, post-reduction, and clinic follow-up were independently reviewed by orthopedic surgeons and radiologists, blinded to clinical outcomes and each other's assessments, using predefined adequacy criteria. Demographic data were extracted from patient records.

Seventy patients were included and completed follow-up. Postreduction adequacy was classified as 53% (95% CI 41.3 to 64.1%) by orthopedic surgeons and 75.7% (95% CI 64.4 to 84.3%) by radiologists. At follow-up, 26 reductions classified as adequate by orthopedic surgeons remained adequate, corresponding to a slippage rate of 29.7% (95% CI 17.4 to 45.9%). Radiologists identified a lower slippage rate of 17.0% (95% CI 9.0 to 29.5%). Seven patients (10%; 95% CI 4.7 to 19.5%) underwent surgery. Agreement between orthopedic surgeons and radiologists was 77.1% (95% CI 66.0 to 85.4%), with a Cohen's kappa of 0.53 (95% CI 0.35 to 0.71). No clear demographic or radiographic pattern distinguished patients undergoing surgery from those managed nonoperatively.

Radiographic assessment of distal radius fracture reduction varied substantially between orthopedic surgeons and radiologists, with only moderate interspecialty agreement. Although most patients did not undergo surgery, radiographic adequacy alone did not consistently explain subsequent management decisions. These findings support an integrated approach to the management of distal radius fractures that incorporates clinical context, patient factors, and functional outcomes alongside imaging, and highlight the need for clearer shared definitions of reduction adequacy across specialties.