Sonography for monitoring closed reduction of displaced extra-articular distal radial fractures

Background: Closed reduction and cast immobilization are employed in the primary treatment of most distal radial fractures, and conventional radiographic techniques have been essential and effective in monitoring these reductions. Radiation-free ultrasonography, however, can provide both real-time and dynamic multiple-plane images with a small and simple-to-use transducer that can be operated with only one hand. We therefore wanted to see if the real-time and dynamic multiple-plane observation capabilities of ultrasonography would allow an orthopaedic surgeon to perform a closed reduction without multiple attempts, as are frequently required when only conventional radiographic techniques are used. Methods: Sonographically guided closed reduction was performed in twenty-seven consecutive wrists with an acute distal radial fracture. The efficacy of this method was evaluated and compared with that of conventional radiographic techniques. Results: The sonographic images delineated the fractures as accurately as did the conventional radiographs. All parameters measured on the sonograms and radiographs showed substantial restoration of anatomic alignment after reduction, and all measurements were similar on the two types of images. Conclusions: Sonographically guided monitoring compared well with conventional radiographic techniques during closed reduction of extra-articular distal radial fractures. Sonography is an accurate, simple, and radiation-free tool that provides the substantial benefits of dynamic multiple-plane and real-time observation.