Point-of-care ultrasound-guided versus standard reduction of displaced distal radius fractures in the emergency department: a randomised controlled clinical trial.

Autor:	Haak SL; Department of Emergency Medicine, Isala, Zwolle, The Netherlands s.l.haak@umcg.nl.; Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands., Borgstede MG; Department of Emergency Medicine, Wilhelmina Hospital Assen, Assen, The Netherlands., Stolmeijer R; Department of Emergency Medicine, University Medical Centre Groningen, Groningen, The Netherlands., Bens BW; Department of Emergency Medicine, University Medical Centre Groningen, Groningen, The Netherlands., Boendermaker AE; Department of Emergency Medicine, Tjongerschans Hospital Heerenveen, Heerenveen, The Netherlands., van der Kolk BBY; Department of Emergency Medicine, Isala, Zwolle, The Netherlands., Ter Maaten JC; Department of Emergency Medicine and Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands., Ter Avest E; Department of Emergency Medicine, University Medical Centre Groningen, Groningen, The Netherlands., Lameijer H; Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
Jazyk:	angličtina
Zdroj:	Emergency medicine journal : EMJ [Emerg Med J] 2023 Nov 28; Vol. 40 (12), pp. 826-831. Date of Electronic Publication: 2023 Nov 28.
DOI:	10.1136/emermed-2023-213178
Abstrakt:	Background: During closed reduction of displaced distal radius fractures, physical examination is used to determine the need for further manipulation before radiographic confirmation and cast application. Manipulation performed under ultrasound guidance has the potential to decrease the number of reduction attempts. Methods: This multicentre randomised controlled trial was undertaken between December 2018 and July 2020 in the ED of four hospitals in the Netherlands. Patients aged ≥16 years presenting to the ED with a distal radius fracture requiring closed reduction were randomised to either point-of-care ultrasound (PoCUS)-guided or standard reduction. The primary outcome was the proportion of patients requiring more than one reduction attempt. The secondary outcomes were time to complete reduction and treatment plan at ED discharge (conservative or operative repair). Results: A total of 214 patients were screened, of which 211 patients were included for primary endpoint analysis (87% female, median age 68 years, 94% dorsal angulation, 59% intra-articular and 73% multifragmentary). In total, 105 patients were randomised to standard treatment and 106 patients to PoCUS-guided fracture reduction. In the standard treatment group, 13 patients (12%) required more than one reduction attempt, compared with 6 patients (6%) in the PoCUS group (OR 2.35, 95% CI 0.86 to 6.45). The median reduction time was 5 min in the PoCUS group (IQR 3-6) vs 3 min (IQR 2-4) in the standard reduction group (p<0.001). At ED discharge, operative repair was indicated for 17 (16%) patients in the standard group and 21 (20%) patients in the PoCUS group (OR 0.78, 95% CI 0.39 to 1.58). Conclusion: This study could not demonstrate that PoCUS-guided reduction of distal radius fractures was associated with a statistically significant decrease in the number of reduction attempts. Trial Registration Number: The Netherlands Trial Register (NTR7934). Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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