Enhanced Recovery After Surgery used in close reduction of distal radius fracture in emergency traumatic patients: a prospective cohort study / 中华创伤骨科杂志

ABSTRACT

Objective@#To compare the therapeutic effects between the anesthetic and non-anesthetic closed reduction protocols for distal radius fractures based on the concept of Enhanced Recovery After Surgery (ERAS).@*Methods@#A prospective study was conducted in a cohort of 186 patients with distal radius fracture who had been admitted to the Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from September 2018 to January 2019. The patients were divided into 2 groups depending on the choice by themselves. Of them, 72 (intervention group) underwent the standardized closed reduction under brachial block anesthesia based on the concept of ERAS while the other 114 (control group) conventional closed reduction under no anesthesia. The 2 groups were compared in terms of emergency reduction times, swelling scores, reoperation rate, splint removal time, functional outcomes by the Patient-Rated Wrist Evaluation (PRWE) and radiographic outcomes by the Lidström criteria.@*Results@#The patients in both groups were followed up for 6 months. The reduction times were fewer in the intervention group than in the control group (1.1±0.1 versus 1.6±0.1, P<0.05). The reoperation rate was significautly lower in the intervention group than in the control group [2.8%(2/72) versus 12.3%(14/114), P< 0.05]. Reduction deteriorated the swelling condition. Compared with the control group, the swelling was significantly less in the intervention group (2.0±0.1 versus 2.6±0.1, P<0.05). The splint removal time for the intervention group (5.3±0.2 weeks) was significantly shorter than that for the control group (6.9±0.2 weeks) (P<0.05). The intervention group had significantly better PWRE scores than the control group (23.4±1.0 versus 30.3±1.1, P<0.05), but there was no significant difference between groups in the Lidström evaluation (P>0.05).@*Conclusion@#Compared with conventional closed reduction, the closed reduction under anesthesia based on the ERAS concept is an effective method for the emergency treatment of distal radius fracture, because it may minimize the patients’ pain experience, increase the rate of successful reduction, decrease the rate of reoperation, shorten the splint fixation time and gain better functional outcomes.