Real-Time Ultrasound Guidance for Distal Radius Fracture Reduction in the Emergency Department
Dr Himanshu Gul Mirani
Case Presentation:
An octogenarian presented to the emergency department following a mechanical fall onto an outstretched hand. The patient reported immediate wrist pain, deformity, and functional limitation. There were no preceding syncopal symptoms or head injury. Examination demonstrated a dorsally angulated distal forearm deformity consistent with a “dinner fork” appearance, with localized swelling and tenderness over the distal radius. Neurovascular assessment of the affected limb was intact. The clinical picture was highly suggestive of a distal radius fracture (Colles’ fracture), and management priorities included confirmation of diagnosis, provision of analgesia, and timely reduction to restore anatomical alignment and function.
Pre - and post - reduction of distal radius fracture (Colles’ fracture)
Management and Outcome:
Plain radiography of the wrist confirmed a dorsally displaced distal radius fracture consistent with a Colles’ fracture. In addition, point-of-care ultrasound (POCUS) was performed at the bedside, demonstrating cortical disruption of the distal radius.
The patient received appropriate analgesia followed by a hematoma block for procedural anesthesia. Closed reduction was performed in the emergency department. During the procedure, POCUS was used to guide reduction by visualizing cortical alignment in real time. Following manipulation, repeat ultrasound demonstrated improved cortical continuity and alignment, suggesting successful reduction. Post-reduction radiographs were subsequently obtained, confirming satisfactory anatomical alignment.
Key Learnings and Points:
This case highlights the expanding role of bedside ultrasound in musculoskeletal interventions, particularly in older patients where timely and effective reduction is essential.
Point-of-care ultrasound can identify cortical breaches in long bone fractures and support initial diagnosis.
POCUS enables real-time guidance during fracture reduction, allowing immediate assessment of alignment.
Integration of POCUS into emergency fracture management enhances procedural accuracy and clinician confidence.