LO062: 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 for 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 5 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 scores for reduction success by PoCUS vs. clinical assessment (Median scores 4 vs.4; p=0.370;) or in the odds ratio of successful reduction (0.89; 95% CI 0.46 to 1.72; p=0.87). Significantly fewer cases fell in the uncertain category with POCUS than with clinical assessment (12 vs 2; p=0.008). Repeat reduction was performed in 49 patients (41.2%). In this group, the odds ratio for adequate reduction assessment post-PoCUS to pre-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. Conclusion: PoCUS guided fracture reduction leads to repeat reduction attempts in approximately 40% of cases, and enhances certainty regarding reduction adequacy when clinical assessment is unclear.