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Three Part Question

During [manipulation of colles fracture in Emergency department] how [useful is an ultrasound scan] at [confirming reduction to avoid remanipulation post x-rays]?

Clinical Scenario

You have attended recently an Emergency Medicine USS Course and your trainer mentioned the use of ultrasound in manipulating colles fracture in ED. You wonder whether there is any evidence that this is effective.

Search Strategy

Medline using National library of health interface

Medline 1950-11/08
{((colles.ti,ab) OR (exp radius/) OR (radius.ti,ab) OR (radial.ti,ab)) AND ((fracture.ti,ab) OR (exp fractures, closed/ OR exp fractures, bone/ OR exp fractures, communited/ OR exp fractures, compression/ OR exp fractures, malunited/ OR exp fractures, ununited/ OR exp radius fractures/ OR exp ulna fractures/) OR (fractures.ti,ab) OR (exp wrist injuries/ OR exp wrist/ OR exp wrist joint/)) AND ((exp ultrasonography OR ultrasonography.mp OR exp ultrasonics OR ultrasonics.mp OR ultrasound.mp))} LIMIT to human AND English.

Search Outcome

Altogether 162 papers found of which 161 were irrelevant or of insufficient quality for inclusion. One paper is shown below.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Tai-Chang Chern et al. 2002. Taiwan	Ultrasound was used during closed reduction in 27 consecutive distal radial fracture age 8-86[48.4]. 21 extra articular, 6 intra articular	observational study	Measurements of fracture displacement and angulation with ultrasound and x-ray	No significant difference between ultrasound and radiographic measurements. All 27 patients had anatomical reductions	Small numbers. Ultrasound can not measure palmar tilting angle, radial shortening distance, radial inclination angle but these values also achieved p<0.05 while correcting other outcomes. No comparison with reduction success without ultrasound

Comment(s)

The use of ultrasound to confirm satisfactory reduction of a colles fracture prior to plaster is an appealing concept, as this is subject to a degree of uncertainty at times. Inadequate manipulation will often necessitate further intervention. This study shows that ultrasound can demonstrate the degree of angulations and displacement in skilled hands. The next step would be to compare clinically relevant outcomes in a randomised study

Clinical Bottom Line

At present there is not enough evidence to recommend Ultrasound for use in the reduction of colles fracture in the ED. Early evidence suggests it might be a useful tool for improving the quality of wrist fracture reduction

References

1. Chern TC; Jou IM; Lai KA; Yang CY; Yeh SH; Cheng SC, et al Sonography for monitoring closed reduction of displaced extra-articular distal radial fractures Journal of Bone & Joint Surgery - American Volume February 2002, vol./is.84-A/2 (194-203), 0021-9355