Distal radius fractures: an evidence-based approach to assessment and management

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

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).

Improvement, Validation, and Analysis of Colles Fracture Treated with an Integrated Retainer Pad Splint

Objective

To observe the effectiveness and safety of the Colles fracture treated with the integrated retainer pad splint and to compare the clinical and radiological outcomes of the integrated retainer pad splint and the traditional bamboo curtain splint in the treatment of the Colles fracture.

Methods

A total of 100 patients with Colles fractures were randomly divided into two groups: the treatment group was fixed with the integrated retainer pad splint (IS), and the control group was fixed with the traditional bamboo curtain splint (TS).The range of wrist motion was measured at follow-up examinations, and volar inclination, ulnar deviation, and radial height were measured on radiographs. Regular follow-up wrist imaging examinations and functional examinations were performed before reduction, after reduction, and at the 1st, 3rd, 5^th, and 8th weeks. The two groups were compared in terms of convenience, fracture healing time, X-ray data of volar inclination, ulnar deviation, radial height, and wrist joint function. The relevant data were analyzed with SPSS 25.0 statistical software.

Results

There were no notable differences in gender, age, and injured side between IS and TS groups. In terms of operation time, IS was better than the TS group (P < 0.05), and the operation time in the IS group was shorter. On the basis of X-ray data of volar inclination, ulnar deviation, and radial height measured on radiographs, the difference between the IS and TS groups was statistically significant (P < 0.05), which showed that the IS group was more stable in fracture fixation and had less reduction loss during the treatment process. At the 8th week of treatment, the wrist Gartland–Werley score of the two groups showed that the two fixation methods are equivalent in restoring wrist joint function (P > 0.05); however, in terms of the excellent and good rate of wrist joint function, the IS group scored 96% was higher than the TS group (80%).

Conclusion

Compared with the traditional bamboo curtain splint, the integrated retainer pad splint is more convenient and stable, and it has less reduction loss during the treatment. Repair of the Colles fracture using the integrated retainer pad splint with external fixation results in nearly normal return of function, which is significantly better than using the traditional bamboo curtain splint.

A research protocol on leap motion tracking device: A novel intervention method in distal radial fracture rehabilitation

Introduction

Physiotherapeutic rehabilitation are used to optimize functional recovery following a distal radial fracture (DRF). Being most common upper limb fracture in all age groups, the DRF peaks in young men and in post-menopausal women with incidence ratio of 1:4. Leap motion control based rehabilitation of patients with DRF is limited. This research aims to assess the efficacy of leap motion control based rehabilitation in patients with DRF.

Methods

In an randomized parallel group trial, subjects (n = 40) with DRF will be recruited. The participants will be enrolled into either experimental or control group with 1:1 allocation ratio. Following the primary assessment and allocation, the participants in experimental group will receive both leap motion control and conventional therapy over a period of six weeks. Participants in conventional group would undergo only conventional therapy. The primary outcome measures will be Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and Universal goniometer however the grip strength and Visual Analog Scale (VAS) will be used as secondary outcome measures.

Purpose of the study

The findings of this trial will examine the impact of leap motion control in DRF patients with conventional therapy on improving the functional activity, range of motion (ROM), grip strength and pain.

Expected clinical implications

To conclude, this research seeks to examine the rapid and long term effects of leap motion control in DRF patients. The study findings would help prospective patients with DRF, which may include a newly designed approach of rehabilitation.