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Point-of-care ultrasound-guided versus standard reduction of displaced distal radius fractures in the emergency department: a randomised controlled clinical trial
  1. Svenja L Haak1,2,
  2. Marion G Borgstede3,
  3. Renate Stolmeijer4,
  4. Bas WJ Bens4,
  5. Annemieke E Boendermaker5,
  6. Brigitta (Britt) YM van der Kolk1,
  7. Jan C ter Maaten6,
  8. Ewoud ter Avest4,
  9. Heleen Lameijer2
  1. 1 Department of Emergency Medicine, Isala, Zwolle, The Netherlands
  2. 2 Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
  3. 3 Department of Emergency Medicine, Wilhelmina Hospital Assen, Assen, The Netherlands
  4. 4 Department of Emergency Medicine, University Medical Centre Groningen, Groningen, The Netherlands
  5. 5 Department of Emergency Medicine, Tjongerschans Hospital Heerenveen, Heerenveen, The Netherlands
  6. 6 Department of Emergency Medicine and Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
  1. Correspondence to Dr Svenja L Haak, Emergency Medicine, Isala, Zwolle, 8025 AB, The Netherlands; s.l.haak{at}


Background During closed reduction of displaced distal radius fractures, physical examination is used to determine the need for further manipulation before radiographic confirmation and cast application. Manipulation performed under ultrasound guidance has the potential to decrease the number of reduction attempts.

Methods This multicentre randomised controlled trial was undertaken between December 2018 and July 2020 in the ED of four hospitals in the Netherlands. Patients aged ≥16 years presenting to the ED with a distal radius fracture requiring closed reduction were randomised to either point-of-care ultrasound (PoCUS)-guided or standard reduction. The primary outcome was the proportion of patients requiring more than one reduction attempt. The secondary outcomes were time to complete reduction and treatment plan at ED discharge (conservative or operative repair).

Results A total of 214 patients were screened, of which 211 patients were included for primary endpoint analysis (87% female, median age 68 years, 94% dorsal angulation, 59% intra-articular and 73% multifragmentary). In total, 105 patients were randomised to standard treatment and 106 patients to PoCUS-guided fracture reduction. In the standard treatment group, 13 patients (12%) required more than one reduction attempt, compared with 6 patients (6%) in the PoCUS group (OR 2.35, 95% CI 0.86 to 6.45). The median reduction time was 5 min in the PoCUS group (IQR 3–6) vs 3 min (IQR 2–4) in the standard reduction group (p<0.001). At ED discharge, operative repair was indicated for 17 (16%) patients in the standard group and 21 (20%) patients in the PoCUS group (OR 0.78, 95% CI 0.39 to 1.58).

Conclusion This study could not demonstrate that PoCUS-guided reduction of distal radius fractures was associated with a statistically significant decrease in the number of reduction attempts.

Trial registration number The Netherlands Trial Register (NTR7934).

  • fractures and dislocations
  • ultrasonography
  • emergency department

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Handling editor David Metcalfe

  • Twitter @Britt_NL, @ewoudteravest

  • Contributors SLH, MGB, RS, BWJB, AEB, BYMvdK, EtA and HL contributed to the data collection. SLH, MGB, RS, EtA and HL contributed to the development of the study design. SLH, MGB, JCtM, EtA and HL contributed to the data analysis and the interpretation of the data. SLH, MGB, JCtM, EtA and HL contributed substantially to writing, editing, revising and finalising the manuscript before submission. All authors critically revised the manuscript and all authors approved the final version of the manuscript. SLH is the guarantor of the study.

  • Funding This study was supported financially by the Spoedeisende Geneeskunde Onderzoeksfonds (SGO; Dutch Emergency Medicine Research Fund; grant number: N/A).

  • Disclaimer The SGO had no involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

  • Competing interests None declared.

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

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.