Quality of Plaster Molding for Distal Radius Fractures Is Improved Through Focused Tuition of Junior Surgeons.
Ramoutar DN., Silk R., Rodrigues JN., Hatton M.
OBJECTIVES: Successful nonoperative management of distal radius fractures requires an adequately reduced fracture held in a well-molded cast. The purpose of this study was to determine whether a targeted teaching session to the same group of junior doctors led to objective improvement in fracture reduction and plaster molding and hence a decrease in the redisplacement of these fractures. DESIGN: Retrospective review. SETTING: Level I academic trauma center. METHODS: A retrospective review of all dorsally angulated distal radius fractures treated in plaster that presented to our plaster room over a 4-week period (group 1, n = 52). This was followed by the intervention and a subsequent 4-week prospective review (group 2, n = 36). Radiographs were reviewed before manipulation, after manipulation, and at follow-up by a single senior orthopaedic trainee using predetermined criteria. INTERVENTION: A targeted teaching session on fracture reduction and cast molding to the same group of junior doctors involved in managing all these cases. MAIN OUTCOME MEASURES: Adequate fracture reduction, plaster molding, redisplacement, and further intervention before and after the targeted intervention. RESULTS: In group 1, 85% had adequate fracture reduction but only 36% showed adequate molding. This was improved in group 2%-94% adequate reduction and 65% adequate molding (P = 0.022). The rate of redisplacement was improved from 65% to 44% in group 2. In both groups, the rate of redisplacement was around 20% for adequately reduced and molded fractures, compared with around 90% for adequately reduced but inadequately molded cases (P < 0.001). The rate of further intervention improved from 27% to 8% (P = 0.052). CONCLUSIONS: We recommend that specific teaching focusing on fracture reduction and molding techniques is included in orthopaedic juniors' induction teaching or as a separate session. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.