Ultrasound-guided reduction of distal radius fractures

Am J Emerg Med. 2010 Nov;28(9):1002-8. doi: 10.1016/j.ajem.2009.05.022. Epub 2010 Mar 26.

Abstract

Introduction: In our local emergency departments (EDs), manipulation and reduction (M&R) of distal radius fractures are performed by emergency doctors, with blind manual palpation, using postreduction x-rays to assess adequacy. We sought to study the effectiveness of ultrasound guidance in the reduction of distal radius fractures in adult patients presenting to a regional ED.

Methods: This was a before-and-after study. Eligible patients were adults older than 21 years who presented to the ED with distal radius fractures that required M&R. Sixty-two patients were prospectively enrolled from October 2007 until June 2008, and they underwent ultrasound-guided M&R. The control group was a retrospective cohort of 102 patients who presented from January to June 2007. They had M&R done using the blind manual palpation method. All M&R procedures were performed by doctors within the ED, and supervision was provided by senior emergency physicians. Ultrasound guidance was performed by the senior emergency physicians.

Results: Baseline characteristics between the ultrasound and control groups were similar. The rate of repeat M&R was reduced in the ultrasound group (1.6% vs 8.8%; P = .056). The postreduction radiographic indices were similar between the 2 groups, although the ultrasound group had improved volar tilt (mean, 5.93° vs 2.61°; P = .048). An incidental finding of a reduced operative rate was also found between the ultrasound and control groups (4.9% vs 16.7%; P = .02).

Conclusion: Ultrasound guidance is effective and recommended for routine use in the reduction of distal radius fractures.

Publication types

  • Clinical Trial

MeSH terms

  • Female
  • Fracture Fixation, Internal / methods
  • Humans
  • Male
  • Manipulation, Orthopedic / methods
  • Middle Aged
  • Prospective Studies
  • Radiography
  • Radius / diagnostic imaging
  • Radius / injuries
  • Radius / surgery
  • Radius Fractures / diagnostic imaging*
  • Radius Fractures / surgery
  • Ultrasonography