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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Can you Teach Orthopaedic Residents Point-Of-Care Ultrasound Techniques for Fracture Assessment and Reduction?
Brian C Lau.MD; Daria Motamedi, MD; Nicolas Lee, MD
University of California San Francisco Medical Center, San Francisco, CA

INTRODUCTION: Point-of-Care ultrasound plays an increasing role in patient care. A recent study, demonstrated that pocket-sized ultrasound may be used in the diagnosis and reduction of distal radius fractures. However, the question remains whether these skills can be taught to orthopedic residents without prior experience in ultrasound. General surgery and internal medicine studies showed that short teaching sessions helped residents can quickly gain screening ultrasound skills for Focused Assessment with Sonography in Trauma (F.A.S.T.), obstetrics, vascular, and abdominal ultrasound. Ultrasound skills with pocket-sized ultrasound, see Figure 1, has not been tested in orthopaedic residents. The purpose of this study was to determine if orthopaedic residents could develop skills in ultrasound for distal radius fractures.

METHODS: Six junior (4-R2 and 2-R3) residents were recruited for the study. They were given a pre-test of ultrasound images (50 cases) of distal radius fractures and asked to determine if the cases were 1) Fractured-Not reduced; 2) Fractured-reduced; 3) Not Fractured. See Figure 2 for examples. Cases were previously compared to a gold-standard radiographs to determine its proper classification by a hand-fellowship trained orthopedist, and a musculoskeletal-trained orthopedist. Following the pre-test; residents were provided a 30-minute tutorial on techniques on obtaining and interpreting distal radius ultrasound. The residents then completed two separate (total 14-16 weeks) trauma rotations where they used ultrasound on distal radius patients. The two trauma rotations spanned over the course of one academic year. Following completion of their second trauma rotation the residents completed a post-test. Pre- and Post- scores for sensitivity and specificity for diagnosing a fracture and determining a satisfactory reduction and comfort scale (Likert scale 0-5) were compared with Student's T test.

RESULTS: The average days from pre- to post-test was 203.7 days. Residents demonstrated a 96.2% sensitivity in diagnosing a fracture during pre- and post-testing. The greatest improvements from pre- to post-testing was in the sensitivity of detecting a reduced or not-reduced fracture (74.8% to 95.8%, p=0.02) and the specificity of determining a fracture or no-fracture (80.6% to 95.8%, p=0.03), see Table 1. The comfort level with ultrasound also significantly increased. Residents expressed a strongly that ultrasound would be useful in the care of distal radius fractures (Table 2).

Discussion: This study demonstrates that ultrasound skills can be easily taught to orthopedic residents. Residents are quick to acquire the skills to interpret ultrasounds of distal radiuses. Residents felt that ultrasound was useful and easy to learn.

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