- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02353065
Sonographic Assessment of Reduction in Colles' Fracture (SONAR)
Colles fractures are a common type of wrist fracture that often requires manipulation in the Emergency Department. Currently xrays are used to assess whether this has been successful, which are done once the plaster cast has been applied. This study will assess whether ultrasound can be used immediately after the manipulation to check the position, before the plaster cast is applied. This would then be followed by an xray as normal.
The aim is to assess the feasibility of a full study to determine which method is faster, causes less pain, and also to assess if either approach reduces the need for repeat attempts at manipulation and surgical repair.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Fractures of the distal radius are a frequent cause for presentation to United Kingdom (UK) Emergency Departments, and the Colles' fracture is the most commonly encountered type. These injuries frequently occur in isolation, or associated with only minor injuries, and reduction of displaced fractures is typically performed by Emergency Physicians at the time of first attendance to the hospital.
The usually sequence of events is clinical examination, x-ray imaging to confirm the fracture, then the reduction is performed with appropriate analgesia or anaesthesia, the arm placed in a plaster backslab, and repeat imaging is taken to confirm adequacy of reduction. If the reduction is not satisfactory, repeat manipulation is required.
Haematoma block and Biers block permit x-ray imaging of the manipulated wrist while the anaesthetic action is still effective, permitting re-manipulation without further administration of local anaesthetic. Sedation is usually kept to as short a time as possible, and is not usually maintained while imaging is performed. There is usually some degree of delay while x-rays are taken and made available for viewing, and this wait prolongs the procedure for the patient and the treating clinician. In addition, Biers block cannot be tolerated for long by most patients, so any delay makes it less likely that a re-manipulation can be achieved within the time the patient can tolerate. If a patient has been sedated, a re-manipulation will require a further sedative (or alternative) procedure with the concomitant risks that entails.
Ideally, imaging would be performed rapidly, immediately at the end of the manipulation, prior to application of plaster, allowing confirmation of the reduction or immediate re-manipulation if necessary. This description of imaging provided at the point of care by the treating clinician, aimed at answering a clearly defined question ('is this an adequate reduction?') matches the description of focussed emergency ultrasound in other applications. If ultrasound could be used to assess fracture reduction, it would have potential to save clinician time, patient time and discomfort, and reduced the need for repeated manipulations and surgical repair.
This study intends to assess the feasibility of a full trial of efficacy comparing ultrasound with x-ray to guide the reduction of these fractures.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Simon Richards
- Phone Number: +44 1642 342589
- Email: s.richards@tees.ac.uk
Study Contact Backup
- Name: Michael Stewart
- Phone Number: +44 7812 203011
- Email: michael.stewart@lthtr.nhs.uk
Study Locations
-
-
Lancashire
-
Preston, Lancashire, United Kingdom, PR2 9HT
- Recruiting
- Royal Preston Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Adults with isolated fractures of the distal radius undergoing manipulation in the Emergency Department with Intravenous Regional Anaesthesia (Biers Block)
Exclusion Criteria:
- Age under 16
- Contraindication to Biers block
- Unable to give informed consent
- Multiple injuries
- Open fracture
- Prisoners
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Control
Assessment of adequacy of reduction by bedside x-ray during period of intravenous regional anaesthesia (Biers block)
|
Portable x-ray of fracture post-reduction
|
Experimental: Ultrasound
Assessment of adequacy of reduction by bedside ultrasound performed by the treating clinician during period of intravenous regional anaesthesia (Biers block)
|
Point of care ultrasound of fracture site during and post-reduction
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The total inflation time of the tourniquet used during the Biers Block
Time Frame: The duration the tourniquet is inflated; complete within 30 minutes of the procedure commencing
|
The total inflation time of tourniquet used for Biers block
|
The duration the tourniquet is inflated; complete within 30 minutes of the procedure commencing
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The total number of manipulations required per patient within the Emergency Department
Time Frame: The duration of the manipulation procedure; complete within 30 minutes of procedure commencing
|
Number of attempts at manipulation within Emergency Department
|
The duration of the manipulation procedure; complete within 30 minutes of procedure commencing
|
Does the use of ultrasound reduce the need for surgical reduction?
Time Frame: Four weeks from visit
|
Need for surgical reduction/fixation
|
Four weeks from visit
|
Does the use of ultrasound reduce the time spent within the Emergency Department?
Time Frame: End of initial ED visit, within twelve hours of initial arrival to the hospital
|
Total time spent within Emergency Department
|
End of initial ED visit, within twelve hours of initial arrival to the hospital
|
Does the use of ultrasound reduce the pain score during the reduction?
Time Frame: End of procedure - within 30 minutes of the procedure commencing
|
Patient reported pain score at the end of the fracture reduction
|
End of procedure - within 30 minutes of the procedure commencing
|
Does the use of ultrasound increase the patient satisfaction?
Time Frame: Four weeks after visit
|
Patient reported satisfaction with reduction of fracture
|
Four weeks after visit
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Simon Richards, Teesside University
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 141/13
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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-
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