Comparative analysis of adult distal radius fracture reduction in the emergency room: fluoroscopy-guided vs. non-fluoroscopy-guided approaches

Introduction: Distal radius fractures are a common injury, typically treated with closed reduction and plaster casting. Fluoroscopy is frequently used during the reduction process to ensure accurate alignment. However, the necessity of fluoroscopy in achieving optimal radiographic outcomes remains uncertain. While fluoroscopy is considered the gold standard in many settings, concerns about radiation exposure and the cost of its routine use, especially in resource-limited environments, have sparked interest in non-fluoroscopy-guided methods. Research objectives: The primary objective of this study is to assess the radiographic outcomes of distal radius fractures after reduction and casting in plaster, comparing cases treated without fluoroscopy to those treated with fluoroscopy during the procedure. Secondary objectives include comparing the groups based on the percentage of fractures meeting conventional indications for surgery or non-surgical treatment after reduction, the average time spent in the emergency department (ED), and follow-up visits to the ED within the subsequent week due to plaster complications. It was hypothesized that fluoroscopy would have a minimal impact on the final X-ray results following closed reduction and casting. Methods: This retrospective study reviewed the records of patients who visited the ED between 2015 and 2021 with distal radius fractures and received initial treatment involving reduction and casting. Patients were divided into two groups: one treated with fluoroscopy-guided closed reduction and the other with non-fluoroscopy-guided techniques. The study compared radiographic and clinical outcomes, including the need for surgery, complications, and return visits to the ED due to plaster-related issues. Statistical analysis was performed to identify significant differences between the two groups. Results: Of the 85 participants included in the study who underwent reduction and casting, 45 were treated with fluoroscopic guidance while 40 were treated without fluoroscopy. No significant differences were found between the two groups in the radiographic outcomes, including radius length, inclination, posterior angulation, and step-off, between the fluoroscopy-guided and non-fluoroscopy-guided groups. Furthermore, no difference was found in the percentage of fractures requiring surgery or in the rate of return visits to the ED due to plaster complications. Although there were some minor differences in posterior angulation and radial height between the groups, these differences did not translate into meaningful clinical benefits, such as improved functional recovery or reduced need for surgery. Conclusions: The use of fluoroscopy did not demonstrate an improvement in radiographic outcomes for conventional measures of closed reduction and casting in distal radius fractures. Additionally, there was no difference in the conventional indications for surgery following the initial reduction between the two groups. These findings suggest that routine use of fluoroscopy in the ED for such fractures may need reconsideration. While fluoroscopy remains the gold standard, non-fluoroscopy-guided reduction could be a viable alternative.