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. 2024 May 6;25(1):303.
doi: 10.1186/s13063-024-08118-5.

Refraining from closed reduction of displaced distal radius fractures in the emergency department-in short: the RECORDED trial

B M Derksen  1 , P A Jawahier  2 , O Wijers  3 , S P Knops  4 , M R de Vries  5 , C C Drijfhout van Hooff  6 , M H J Verhofstad  7 , N W L Schep  2
Affiliations

Refraining from closed reduction of displaced distal radius fractures in the emergency department-in short: the RECORDED trial

B M Derksen et al. Trials. .

Abstract

Background: With roughly 45,000 adult patients each year, distal radius fractures are one of the most common fractures in the emergency department. Approximately 60% of all these fractures are displaced and require surgery. The current guidelines advise to perform closed reduction of these fractures awaiting surgery, as it may lead to post-reduction pain relief and release tension of the surrounding neurovascular structures. Recent studies have shown that successful reduction does not warrant conservative treatment, while patients find it painful or even traumatizing. The aim of this study is to determine whether closed reduction can be safely abandoned in these patients.

Methods: In this multicenter randomized clinical trial, we will randomize between closed reduction followed by plaster casting and only plaster casting. Patients aged 18 to 75 years, presenting at the emergency department with a displaced distal radial fracture and requiring surgery according to the attending surgeon, are eligible for inclusion. Primary outcome is pain assessed with daily VAS scores from the visit to the emergency department until surgery. Secondary outcomes are function assessed by PRWHE, length of stay at the emergency department, length of surgery, return to work, patient satisfaction, and complications. A total of 134 patients will be included in this study with follow-up of 1 year.

Discussion: If our study shows that patients who did not receive closed reduction experience no significant drawbacks, we might be able to reorganize the initial care for distal radial fractures in the emergency department. If surgery is warranted, the patient can be sent home with a plaster cast to await the call for admission, decreasing the time spend in the emergency room drastically.

Trial registration: This trial was registered on January 27, 2023.

Keywords: Closed reduction; Cost-effectiveness; Distal radius fracture; Surgery.

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Conflict of interest statement

The authors declare that they have received funding from a regional non-profit organization called “Beter Keten.” The study funder will be updated on the progress of the study but is not involved in the study design, data collection, analysis, interpretation, or writing of the manuscript.

Figures

Fig. 1
Fig. 1
Power curve for simulation 1 assuming of balanced clusters (equal number of patients included per center)
Fig. 2
Fig. 2
Power curve for simulation 2 assuming unbalanced clusters (unequal number of patients included per center) and adjustment for seasonal effects
See this image and copyright information in PMC

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