Ultrasound-directed reduction of distal radius fractures in adults: a systematic review

Abstract

ObjectiveTo conduct a systematic review of the clinical literature to determine whether ultrasound can be used to improve the reduction of distal radius fractures in adults in the ED.MethodologyA study protocol was registered on PROSPERO. EMBASE, PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov of the US National Library of Medicine were searched for studies evaluating ultrasound-assisted distal radial fracture reductions in comparison with standard care. The primary outcome of interest was manipulation success rates, defined as the proportion of fracture manipulations resulting in acceptable anatomical alignment, with secondary outcome being subsequent surgical intervention rates in ultrasound and standard care group of patients.Results248 were screened at title and abstract, and 10 studies were included for a narrative synthesis. The quality of this evidence is limited but suggests ultrasound is accurate in determining distal radius fracture reduction and may improve the quality of reduction compared with standard care. However, there is insufficient evidence to determine whether this affects the rate of subsequent surgical intervention or functional outcome.ConclusionThere is a lack of evidence that using ultrasound in the closed reduction of distal radius fractures benefits patients. Properly conducted randomised controlled trials with patient-orientated outcomes are crucial to investigate this technology.

Pragmatic use of ultrasound in plaster room

“…Two recent systematic reviews showed that ultrasound guide does not prevent malreduction after manipulation of distal radial wrist fracture. 7,8 Nema et al found that ultrasound decrease only 10% in risk of malalignment. 8 Differently from X-ray, ultrasound cannot visualize articular surface fragments, it will not allow a tridimensional view of malalignment and this sometimes cause an overestimation of reduction obtained.…”

“…Two recent systematic reviews showed that ultrasound guide does not prevent malreduction after manipulation of distal radial wrist fracture 7,8 . Nema et al found that ultrasound decrease only 10% in risk of malalignment 8…”

Ultrasound-Guided Manipulation does not Prevent Malalignment Over Landmark-Based Fracture Reduction in Distal Radius Fracture (Colles)

“…Distal radius fractures (DRF) account for one-sixth of fractures in accident and emergency. [ 1 ] Manipulation and reduction (M&R) followed by splint application is the most acceptable treatment for extra-articular and minimally displaced intra-articular DRF. Nevertheless, the high risk of failure of M&R or a need for operative intervention is the cause of concern in these injuries.…”

“…Recently, several studies have investigated the role of ultrasound (USG) in guiding M&R in DRF. [ 1 ] While the landmark-based technique is an established method for DRF M&R, USG offers a real-time assessment of fracture alignment. The claimed benefits of USG for DRF M&R include increased reduction accuracy and a decrease in emergency room (ER) waiting time; however, it is associated with increased costs and training.…”

“…reviewed the accuracy of USG-directed M&R in DRF. [ 1 ] However, their review was limited to a narrative synthesis of the included studies. [ 1 ] It reviewed two studies with mixed populations of children and adults.…”