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

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.

Study Overview

• Status: Completed
• Conditions: Point-of-care Ultrasound, Distal Radius Fracture
• Intervention / Treatment: Procedure: Closed fracture reduction; Device: Point-of-care ultrasound

• Study Type: Interventional
• Enrollment (Actual): 22
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • London, Ontario, Canada, N6A 5W9
      • London Health Sciences Centre
    • London, Ontario, Canada, N6A 4V2
      • St. Joseph's Health Care London

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

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

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Standard of care; 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; 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
Experimental: Experimental Group; 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.	Procedure: Closed fracture reduction; 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; Device: Point-of-care ultrasound; 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.; Other Names: POCUS

What is the study measuring?

Primary Outcome Measures

Outcome Measure	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

Collaborators and Investigators

• Sponsor: Marcus Van Aarsen
• Collaborators: Lawson Health Research Institute

Study record dates

Study Major Dates

• Study Start (Actual): January 10, 2017
• Primary Completion (Actual): June 18, 2018
• Study Completion (Actual): June 30, 2018

Study Registration Dates

• First Submitted: November 2, 2016
• First Submitted That Met QC Criteria: November 10, 2016
• First Posted (Estimated): November 11, 2016

Study Record Updates

• Last Update Posted (Actual): July 29, 2024
• Last Update Submitted That Met QC Criteria: July 25, 2024
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Wounds and Injuries; Arm Injuries; Forearm Injuries; Wrist Injuries; Fractures, Bone; Radius Fractures; Wrist Fractures
• Other Study ID Numbers: 107331