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Ultrasound-directed reduction of distal radius fractures in adults: a systematic review
  1. Hamza Malik1,
  2. Andrew Appelboam2,
  3. Michael Nunns3
  1. 1Emergency Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  2. 2Emergency Department, Royal Devon and Exeter Foundation Trust, Exeter, UK
  3. 3Exeter Policy Research Programme, Evidence Review Facility, Exeter, UK
  1. Correspondence to Dr Hamza Malik, Emergency Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW, UK; hamza.malik1{at}nhs.net

Abstract

Objective To 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.

Methodology A 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.

Results 248 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.

Conclusion There 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.

  • ultrasound
  • musculo-skeletal
  • fractures and dislocations
  • emergency department management

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information

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Footnotes

  • Handling editor Margaret Samuels-Kalow

  • Contributors HM conceived the original idea for this study, was the first reviewer, and undertook write-up of the first draft and subsequent revised versions. AA was the second reviewer, supervised the production of the manuscript, and contributed to the initial draft and subsequent revised versions. MN supervised the production of the manuscript, and contributed to the initial draft and subsequent revised versions. All authors approved the final version for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • 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.

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