Increased Efficiency with Use of a Mini C Arm in Emergency Department Closed Reductions.

Abstract

To determine if use of a mini C-arm increased emergency department efficiency and decreased patient radiation exposure and the frequency of repeat closed reductions, as compared to traditional post-reduction radiographs in isolated distal radius and ankle fracture patients. Design: Retrospective chart review. Academic Level 1 Trauma Center. Adult patients with an isolated distal radius (OTA/AO 2R3A2), bimalleolar or trimalleolar ankle (OTA/AO 44B1) fractures requiring closed reduction by the orthopaedic surgery team in an academic level 1 trauma center emergency department (ED) from 2013-2023 were included. Patients with pathologic fractures were excluded. Closed reductions in which mini C-arm imaging was utilized were compared to those that utilized traditional post-reduction radiographs. Total radiation exposure to the patient during the encounter (mGy), closed reduction radiation exposure (mGy), the number of repeated reductions in the ED requiring an additional analgesic/anesthetic event and splint application, orthopaedic consult time, doctor visit to discharge time, and time under sedation (conscious or unconscious) were compared between the mini C-arm group and the traditional post-reduction radiographs group. 199 subjects met inclusion criteria (81 ankle fractures and 118 distal radius fractures). For the mini C-arm group, the mean age was 59 years (range 25-93) and 58% of the patients were female (n = 14). For the traditional post-reduction radiographs group, the mean age was 58 years (range 21-90) and 55% of the patients were female (n = 96). Use of a mini C-arm (16 ankle fractures and 8 distal radius fractures) versus traditional post-reduction radiographs (65 ankle fractures and 110 distal radius fractures) resulted in significantly lower total radiation exposure, 0.9 mGy versus 0.4 mGy (p<0.001), and closed reduction radiation exposure, 0.5 versus 0.1 mGy (p<0.001); fewer repeated reductions,65 versus 0 repeated reductions (p<0.001); and shorter time from doctor visit to discharge, 6.2 versus 3.8 hours (p<0.001), orthopaedic consult time, 4.0 versus 1.7 hours (p<0.001), and time under sedation, 37 versus 26 minutes (p=0.046). This study found that the use of a mini C-arm compared to traditional post-reduction radiographs for distal radius and ankle fracture closed reductions improved ED efficiency and decreased patient radiation exposure and repeated closed reductions. Level III.