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Results of Distal Radius Fracture Reduction in the Emergency Department With or Without Fluoroscopic Assistance
Nicholas Crosby, MD; Daniel Tayag, MD; Tom Hong, MD; John Lubahn, MD; UPMC Hamot
UPMC Hamot, Erie, PA, USA

Introduction: Reduction of distal radius fractures in the emergency department (ED) is a common procedure for orthopaedic residents. Fluoroscopic assistance with mini c-arm imaging is sometimes utilized, but availability varies between hospitals.  It is not well understood what benefit, if any, fluoroscopic assistance provides in fracture reduction.  We hypothesize that no differences in radiographic and clinical outcomes exist between distal radius fractures reduced with or without fluoroscopic assistance.

Materials and Methods:  Preliminary evaluation of a prospective, randomized cohort of 27 adults with displaced distal radius fractures treated with closed reduction and splinting in the ED was performed. Following inclusion with informed consent, subjects were randomly assigned to fracture reduction with or without c-arm use.  Reduction and splinting followed strict and uniform protocol guidelines.  Outcomes include standard radiographic parameters or volar tilt, radial inclination, radial height, and intra-articular step-off.  Data sheets were reviewed to determine the total consultation time and need for repeat reductions, and office notes were used to determine definitive surgical treatment.  Student's t-test was used to compare the means outcomes between the groups, and ANCOVA was used to compare reduction quality while controlling for variables.

Results: 27 distal radius fractures, (14 fluoroscopy-assisted, 13 non-fluoroscopy controls) have been enrolled in the study. Overall, no significant demographic differences between groups are noted with the exception of age as seen in Table 1.  Several data trends were noted, but aside from pre-reduction radial inclination, no significant differences in the pre- and post-reduction alignment parameters are noted.  Time of consultation was the only outcome measure to reach statistical significance (Table 2).  Although more patients in the fluoroscopic group went on to surgery, it was not statistically significant and may be related to age differences between the groups.  ANCOVA analysis shows no difference in fracture reduction quality within subjects and between groups.

Conclusions: Preliminary results suggest that use of fluoroscopic assistance with distal radius fracture reduction decreases total orthopaedic consultation time, but no difference in quality of reduction is appreciated.  Differences between group data show clinical trends, and further enrollment may increase study power sufficiently to provide statistical significance in several outcome measures. 

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