A Novel Curriculum for Reducing Distal Radius Fractures in an Emergency Medicine Residency Program
Abstract
Learning Objectives: We developed a curriculum using a high-fidelity model for residents to learn proper reduction of closed, stable distal radius fractures without orthopedic consultation.
Background: EM residents are expected by the ACGME to be competent in managing orthopedic injuries. Given that these injuries make up 20% of ED visits, it is essential that residents feel comfortable and competent in managing them. In a recent survey sent to alumni of several EM residencies, more than half of respondents reported feeling not at all or somewhat prepared to independently reduce closed fractures. They also stated seeing wrist and distal radius and ulna fractures most frequently. We also received resident feedback from our own program that they felt uncomfortable reducing these fractures without orthopedic consultation, even though it fell within their scope of practice.
Educational Objectives: We developed a curriculum using a high-fidelity model for residents to learn proper reduction of closed, stable distal radius fractures without orthopedic consultation.
Curricular Design: Residents were given pre-reading materials on distal radius fracture reduction. During the session, residents were shown a brief presentation on the finger trap reduction technique and relevant anatomy. They were then given a demonstration by faculty using a SawBones high-fidelity simulation arm model. The simulation arm bones are radiopaque, allowing for both pre- and post-reduction x-rays in order to display proper alignment. After demonstration of reduction and radiographic confirmation, residents were able to practice closed reduction and x-ray interpretation under direct supervision.
Impact/Effectiveness: We administered an identical six-question survey before and after in which we assessed residents’ current comfort level with distal radius fracture reduction and splinting. Few residents (17%) initially reported feeling comfortable reducing closed distal radius fractures. After the intervention, almost all residents (88%) reported feeling comfortable. We are currently collecting follow-up data on comfort and frequency of orthopedic consults in the ED.