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Colles’ type distal radial fractures undergoing manipulation in the ED: a multicentre observational cohort study
  1. Hamza Malik1,
  2. Andrew Appelboam1,
  3. Gordon Taylor2
  1. 1 Emergency Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  2. 2 Medical Statistics, RDS SW, University of Exeter Medical School, St Luke’s Campus, Exeter, UK
  1. Correspondence to Dr Hamza Malik, Emergency Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter EX4 3BZ, UK; hamza.malik1{at}nhs.net

Abstract

Background Colles’ type fractures of the distal radius are one of the most commonly manipulated fractures in the ED. Local audit data suggest that a high proportion of these injuries undergo subsequent surgical fixation. If widespread, this could represent a potential burden on patients and the NHS worthy of further research. The aims of this study were to estimate the rate of surgical fixation of Colles’ type distal radial fractures after ED fracture manipulation and explore variations in their management in UK EDs.

Methods We conducted a multicentre observational study in 16 EDs in the UK from 4 February 2019 to 31 March 2019. All adult patients with a Colles’ fracture who underwent fracture manipulation in the ED were included. Patients who could not be followed up and those with volar displaced fractures were excluded. We measured the rate of wrist fracture surgery at 6 weeks, patient demographics and variations in anaesthetic technique used.

Results During the study period, 328 adult patients attended the participating EDs with a distal radial fracture. Of these, 83 patients underwent fracture manipulation in the ED and were eligible for the study. Their mean age (SD) was 65.3 (17.0) years, 84.3% were female and the most common method of anaesthesia used was haematoma block (38.6%). 34 (41.0%, 95 % CI 30.3 to 52.3) patients had subsequent surgical fixation of their fracture. Younger age was associated with higher rates of surgical fixation but ED anaesthetic technique did not affect the subsequent need for surgery in this sample.

Conclusion Subsequent surgical fixation was carried out in 41% of patients who underwent manipulation of Colles’ type wrist fractures in this cohort. This merits further research and represents a potential target to rationalise repeat procedures.

  • emergency department
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Footnotes

  • Handling editor Jason E Smith

  • Collaborators The authors would particularly like to thank the following for collaborating in this research project: Evangeline Letch, Taliesin Hawkins, Meghan Hallatt, Dr Matthew Reed, Jasmine Shen, Eleanor van der Zanden, Dr Ian Wilkinson, Reddin Ahmad, Meghan Hallatt, Dr Robert Miller, Lorraine Pinto, Sarah Aspland, Victoria Lyle, Ben Clarke, Mohammad Mansoor, Amy Fisher, Max Sugarman, Rob Kirkham, Rachael Brennand, Dr Muhammad Awais Cheema, Simon Joshua, Ellen Macpherson.

  • Contributors HM conceived the original idea for this study, conducted the original study, undertook data analysis, write-up of the first draft and subsequent revised versions and approved the final version for publication. AA conceived the original idea for this study, supervised the conduct of the study, supervised the production of the manuscript, contributed to the initial draft and subsequent revised versions and approved the final version for publication. GT supervised the production of the manuscript, contributed to the initial draft and subsequent revised versions and approved the final version for publication.

  • Funding This survey is a part of a project called UDiReCT (Ultrasound Directed Reduction of Colles’ Type distal radial fractures in ED), which has received a research grant from the Royal College of Emergency Medicine.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved as a survey/service evaluation by the Research and Development Department of Royal Devon and Exeter Hospital NHS Foundation Trust, the sponsor for this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data can be requested from the corresponding author of this submission.

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