• Amar Winayak, Alyza Gossat, Jenny Cooper, Peter Ritchie, Wei Lim, Sharon Klim, and Anne-Maree Kelly.
• Department of Emergency Medicine, Western Health, Melbourne, Victoria, Australia.
• Emerg Med Australas. 2018 Feb 1; 30 (1): 42-46.

ObjectiveResearch suggests that the presence of instability markers in patients with displaced distal radial fractures is associated with poorer outcome. Our aims were to determine whether the presence of previously defined instability markers could predict the likelihood of successful ED reduction and requirement for a secondary procedure after ED reduction.MethodsRetrospective cohort study performed by medical record review. Adult ED patients coded as having an isolated wrist fracture and having fracture reduction in ED were eligible for inclusion. Data collected included demographics, history of osteoporosis, mechanism of injury, radiological features on X-rays and performance of a secondary procedure. Outcomes of interest were the rate of successful fracture reduction in ED (against defined radiological criteria), the rate of secondary procedures and the association between the number of defined instability risk factors and successful reduction and performance of a secondary surgical procedure. Analysis was by χ2 test, receiver operating characteristic curve, logistic regression analyses.ResultsThree hundred and nineteen patients were studied; median age 62 years, 77% female. Sixty-five per cent of patients had satisfactory fracture reduction in ED (95% CI 59%-70%). Eighty-six patients underwent a secondary procedure to reduce/stabilise their fracture (28%, 95% CI 23%-33%). Younger age, lack of satisfactory ED reduction and increased number of instability factors were independently predictive of the performance of a secondary procedure.ConclusionInstability risk factors are common in patients with wrist fractures requiring reduction in ED. The number of instability factors is not a strong predictor of the performance of secondary procedures.© 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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