Wrist Reduction Instruction with Simulation Technology for Emergency Medicine Residents (1090-002180) (Technical Proceedings Manuscript Oral Presentations: Simulators, Task Trainers, Modifications)
Start time: Thursday, January 21, 2021, 2:00 PM End time: Thursday, January 21, 2021, 3:00 PM Session Type: Technical Proceedings
Introduction: Distal radius (Colles’) fractures account for one-sixth of all adult fractures and one-third of pediatric fractures in Emergency Departments (ED). One-third of ED-reduced Colles fractures are inadequately reduced and require further treatment. In light of orthopedic simulation literature supporting realistic Colles' fracture management with reliable performance metrics, the investigators implemented an interdisciplinary simulation-based training intervention to improve Emergency Provider (EP) Colles' fracture reduction skills. Methods: Twenty eligible EPs with limited Colles’ fracture reduction experience were enrolled from 2016 to 2017 at a single tertiary academic center. Learner performances were assessed using a commercial Colles’ fracture simulator model and a mini-C arm to measure post-reduction fracture angulation and displacement. Learners completed a baseline-simulated reduction and a repeat-simulated reduction, then received a video didactic on expert distal radius reduction techniques, followed by a third reduction. The differences in post-reduction measurements were compared across the subjects' three reductions with a one-way ANOVA. Acceptable angulation ranges were 10° dorsal angulation and 5° radial angulation. Results: Learners exhibited significant improvements in completing adequate simulated reductions with respect to adequate AP (anterior-posterior) displacement and lateral displacement (p<0.005); composite scores for reduction adequacy showed improvement (p=0.003). Post-reduction measurements across simulations improved for AP angulation, lateral angulation, and lateral displacement (p<0.05). Conclusion: The use of a Colles’ fracture model with video didactic and hands-on support from senior orthopedic clinicians can improve EP reduction performance. Future studies will be required to determine the educational intervention knowledge retention rate, patient outcomes, and inter-facility patient transfers for orthopedic consultations.