The Effect of Point-of-care Ultrasound Guidance for Distal Radius Fracture Reduction

Study Overview
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Brief Summary
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Distal radius (Colle's) fractures in adult patients are commonly reduced in the emergency department before casting. Standard of care currently requires that x-rays be performed before and after fracture reduction, and inadequate reductions may be subject to repeat attempts and are at a higher risk to require surgery. This study will assess the use of point-of-care ultrasound (POCUS) in addition to standard care as a tool to decrease the angulation at the fracture site after a reduction is performed. If this angulation is decreased, it would suggest that POCUS for distal radius fracture reduction could decrease the number of failed reduction attempts and therefore the number of repeated reduction attempts.

Official Title
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The Effect of Point-of-care Ultrasound Guidance for Distal Radius Fracture Reduction

Conditions
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Point-of-care Ultrasound, Distal Radius Fracture

Intervention / Treatment
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* Device: Point-of-care ultrasound
* Procedure: Closed fracture reduction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: radiographically confirmed distal radius fracture Exclusion Criteria: patients who do not consent patients with multiple acute injuries, open fractures, or other local fractures evident (a simple ulnar styloid fracture will not be considered an exclusion criterion) patients with neurovascular compromise patients with bilateral distal radius fractures patients with minimally displaced distal radius fractures that do not require closed reduction before casting

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Standard of care<br>Patients will undergo standard closed fracture reduction. The sedation type, reduction method, and immobilization method will be at the discretion of the treating physician. Point-of-care ultrasound will not be used. | Procedure: Closed fracture reduction<br>* The distal radius fracture will be reduced with using a combination of local anesthetic, sedation, reduction maneouvers and immobiliazation at the discretion of the treating physician<br>|
| Experimental: Experimental Group<br>Patients will undergo standard closed fracture reduction with the addition of point-of-care ultrasound use to assess post-reduction dorsal angulation. The sedation type, reduction method, and immobilization method will be at the discretion of the treating physician. | Device: Point-of-care ultrasound<br>* After the fracture reduction maneouver, the physician will assess residual dorsal angulation using point-of-care ultrasound. If deemed adequate, the physician will progress to immobilization. If the reduction is not adequate, the physician will attempt further reduction at their discretion.<br>* Other names: POCUS;Procedure: Closed fracture reduction<br>* The distal radius fracture will be reduced with using a combination of local anesthetic, sedation, reduction maneouvers and immobiliazation at the discretion of the treating physician<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Residual dorsal angulation |  | Collected at the same-day post-reduction xray. Data will be aggregated over 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Need for orthopaedic surgery within 6 weeks of injury | To be acquired via electronic patient charting | To be assessed 6 weeks post-injury. Data will be aggregated over the 1 year study period | 
| Physician satisfaction: post-reduction questionnaire |  | Questionnaire to be administered immediately after reduction. Data to be aggregated during the 1 year study period |