Examining orthopedic resident reductions of extra-articular distal radius fractures [presentation]
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Resident education continues to evolve under the direction of the American Council for Graduate Medical Education (ACGME). Residency programs strive to develop appropriate methods for assessment of the established core competencies. Distal radius fractures are one of the most common fractures treated by orthopedic surgeons and provide an appropriate disease entity to evaluate resident progress. It is plausible that increased experience with distal radius fractures leads to improved reductions. However, it is unclear whether orthopedic resident reductions improve with increased experience and whether this affects the rate of surgical intervention. PATIENTS AND METHODS: A hospital database identified patients with closed, extra-articular distal radius fractures that underwent closed reduction by a second-year orthopedic resident. Date of reduction was matched to the corresponding day on rotation for the involved resident. Pre- and post-reduction measurements for each fracture included ulnar variance, radial inclination, radial height, and dorsal/palmar angulation. Post-reduction radiographic measurements were compared to resident experience. RESULTS: There were 28 fractures that met inclusion criteria. There was an improvement in radiographic measurements (radial height, radial inclination, and palmar angulation) over a sixmonth trauma rotation. Statistical significance was achieved for radial height (p=0.044) and radial inclination (p=0.030). The majority (71%) of fractures went on to surgical fixation. There was no difference in the length of emergency department visit between the hematoma block and conscious sedation groups. CONCLUSIONS: Second-year orthopedic resident reductions of distal radius fractures improve by radiographic criteria during a consecutive six-month trauma rotation. However, there is no evidence that resident experience changes the overall probability of subsequent operative intervention.
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