Ultrasound-guided reduction of distal radius fractures.
BACKGROUND
Ultrasound (US) may provide the emergency physician with the ability to do real-time assessment of fracture reduction adequacy.


OBJECTIVE
To assess whether US guidance aids in determining the adequacy of distal radius fracture reduction in the emergency department (ED), and to compare the rates of successful reduction with and without US.


METHODS
We conducted a prospective study of patients who underwent US-guided reduction of a distal radius fracture, compared to a historical cohort without US guidance. After performing US-guided reduction, but before post-reduction radiographs, physicians filled out a form stating whether reduction was successful or unsuccessful. Successful radiographic reduction was determined by two orthopedic surgeons based on radiographic findings. Main outcome measures were the sensitivity and specificity of US-guided ED physician assessment of successful reduction, and reduction success compared against the historical cohort.


RESULTS
We enrolled 46 patients in the US-guided group and compared them to 44 patients in the historical cohort. Pre-reduction characteristics were similar in both groups. Physician assessment of reduction success by US had a sensitivity of 94% (95% confidence interval [CI] 88-98%) and specificity of 56% (95% CI 31-71%) for identifying a successful reduction on post-reduction radiographs. The overall success rates of the US-guided and control groups were similar (83% and 80%, respectively).


CONCLUSIONS
Physicians had a high sensitivity in predicting adequate reduction of distal radius fractures using US guidance in the ED. The overall rate of successful fracture reduction was similar with or without US. Further study may determine whether US guidance reduces the time spent in the ED for fracture reduction.
Chinnock
Brian
B
Department of Emergency Medicine, University of California, San Francisco-Fresno Medical Education Program, Fresno, California 93701, USA.
Khaletskiy
Alexander
A
Kuo
Kane
K
Hendey
Gregory W
GW
D000046:Academic Medical Centers; D015331:Cohort Studies; D016001:Confidence Intervals; D004636:Emergency Service, Hospital; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011885:Radius Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D012016:Reference Values; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014505:Urban Population; D014954:Wrist Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery