The Effect of Fluoroscopy in Distal Radius Fractures Reductions on the Radiographic Outcomes

Background:
The majority of displaced distal radius fractures presented to the emergency department are initially treated by Closed reduction and immobilization. The primary goal is to achieve an optimal fracture alignment, and perform a radiographic assessment, as the quality of reduction can influence definitive management. Mini C-arm fluoroscopy provides a real-time assessment of fracture reduction and can theoretically improve the radiographic and clinical outcome.

Methods:
A retrospective cohort analysis of eighty-five patients with DRF between 2015 and 2021 was conducted in a single trauma center. All patients underwent closed reduction and immobilization in a cast. Demographics and radiographic data were compared between the fluoroscopy-assisted group to those treated without fluoroscopy. The primary outcome measurement was reduction quality as measured on postreduction radiographs. Revisits and average time in the ED were also noted.

Results:
45 patients underwent fluoroscopically aided reductions, while 40 patients underwent reduction without fluoroscopy. No differences in postreduction radiographic parameters, including: radial length, radial inclination, Dorsal angulation or intra-articular step-off were observed. In addition, the fluoroscopy and nonfluoroscopy groups did not demonstrate significant differences regarding indication for surgery, average time duration in the ED, and the number of patients who revisited the ED in the following week due to cast complications.

Conclusions:
Fluoroscopy assisted reduction of distal radius fractures with dorsal angulation and radial shortening in the ED did not improve radiographic outcomes. The results of this study, as well as previous studies, suggests a reevaluation of the role of fluoroscopy in ED fracture management.