Objective: Distal radial fracture reduction is a common procedure in the ED. Previous studies have suggested that ultrasound (US)-guided reduction improves outcomes for patients who undergo manipulation and reduction of distal radial fractures in the ED. We aimed to investigate this with the first randomised controlled trial looking at US-guided distal radial fracture reduction. Our primary objective was to compare rates of operative intervention between the study groups. Rate of remanipulation was compared as a secondary outcome. Methods: ED patients were prospectively randomised to either standard landmark guided or US-guided closed reduction of distal radial fractures. The closed reductions were performed by senior emergency clinicians and the USs were performed by emergency physicians experienced in point-of-care US. Following reduction patients were managed equally and referred to the local orthopaedic service who were blinded to whether US was used to assist manipulation or not. This service decided on the need for re-manipulation or operative intervention. Results: One hundred patients were enrolled and randomised equally into each cohort. We found no statistically significant difference between the control and intervention groups of our study. In the control group, 46% of patients underwent operative fixation, compared to 48% in the US-guided group (P = 0.36). Our secondary intervention of re-manipulation in the ED or theatre following the initial reduction showed no statistically significant difference between the groups (P = 1.0). Conclusion: US-guided reduction of dorsally displaced, distal radius fractures in the ED setting, did not improve measured clinical outcomes.
Extensor tendon injuries are classified as per the zone of injury. Zone 1 injuries disrupt the lateral bands with resultant inability to extend the distal interphalangeal joint. Open Zone 1 injuries have many well-described treatment options. To date, none of these have been compared directly. Our aim was to compare the benefit of additional Kirschner-wire fixation with suture repair and splinting of open Zone 1 extensor tendon injuries. We performed a retrospective cohort analysis comparing 2 different surgical procedures, "Suture and Splint" versus "Suture, Splint, and Kirschner wire." The 2 outcomes measured were final range of movement and lag. We had a total of 50 patients. There was no difference in range of motion and the mean length of splint time between the 2 groups. There was increased incidence of lag associated with Kirschner-wire group.
We have described a reduction technique for posterior hip dislocations. Placing the patient's knee over the shoulder, and holding the lower leg like a 'Rocket Launcher' allow the physician's shoulder to work as a fulcrum, thus mechanically and ergonomically superior to standard techniques.
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