Quality of Plaster Molding for Distal Radius Fractures Is Improved Through Focused Tuition of Junior Surgeons

Abstract

Successful nonoperative management of distal radius fractures requires an adequately reduced fracture held in a well-molded cast. The purpose of this study was to determine whether a targeted teaching session to the same group of junior doctors led to objective improvement in fracture reduction and plaster molding and hence a decrease in the redisplacement of these fractures. Retrospective review. Level I academic trauma center. A retrospective review of all dorsally angulated distal radius fractures treated in plaster that presented to our plaster room over a 4-week period (group 1, n = 52). This was followed by the intervention and a subsequent 4-week prospective review (group 2, n = 36). Radiographs were reviewed before manipulation, after manipulation, and at follow-up by a single senior orthopaedic trainee using predetermined criteria. A targeted teaching session on fracture reduction and cast molding to the same group of junior doctors involved in managing all these cases. Adequate fracture reduction, plaster molding, redisplacement, and further intervention before and after the targeted intervention. In group 1, 85% had adequate fracture reduction but only 36% showed adequate molding. This was improved in group 2%-94% adequate reduction and 65% adequate molding (P = 0.022). The rate of redisplacement was improved from 65% to 44% in group 2. In both groups, the rate of redisplacement was around 20% for adequately reduced and molded fractures, compared with around 90% for adequately reduced but inadequately molded cases (P < 0.001). The rate of further intervention improved from 27% to 8% (P = 0.052). We recommend that specific teaching focusing on fracture reduction and molding techniques is included in orthopaedic juniors' induction teaching or as a separate session. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.