Ultrasound-guided reduction of distal radius fractures

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 degrees vs 2.61 degrees; 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. (C) 2010 Elsevier Inc. All rights reserved.