No clinical evidence was found on which to base a judgement around timing of reduction or whether fractures should be reduced using an image intensifier (real time image guidance). As there is also an additional cost for the equipment required in ED to perform the reduction under image intensification, and without any clinical or economic evidence, the GDG decided that a research recommendation was necessary. It also removes the need to administer further anaesthetics for reduction which increases costs. Using an image intensifier for those who can be reduced in ED is likely to reduce the time to a successful reduction and reduces the need for re-manipulation and reimaging. ![]() Due to the lack of clinical evidence, the GDG decided to make a research recommendation. In some patients a closed reduction may be unnecessary prior to the decision for surgery and this increases the burden on the ED and adds unnecessary costs for the treatment time in ED. No economic evidence was identified for either question.Ĭurrent practice for patients who present to ED with a distal radial fracture is to perform an initial closed reduction in ED and then refer the patient to the fracture clinic for a decision regarding further surgical treatment. No clinical evidence was identified for either question. Trade-off between clinical benefits and harms Important outcomes were pain/discomfort and return to normal activities. Research recommendation: For patients with displaced fractures of the distal radius, is manipulation with real-time image guidance more clinically and cost effective than manipulation without real-time image guidance?Ĭritical outcomes were need for health-related quality of life, re-manipulation, need for surgical fixation, and patient-reported function.
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