Priority 14 from the Broken Bones of the Upper Limb in People over 50

UNCERTAINTY: Does when, how and who manipulates an upper limb fracture (returns the fractured bone to its normal position) influence outcome in people over 50? (JLA PSP Priority 14)
Overall ranking	14
JLA question ID	0093/14
Explanatory note	Not available
Evidence	National Institute for Health and Care Excellence. Fractures (non-complex): assessment and management (NG38). London: NICE, 2016. Handoll HHG, Madhok R; Closed reduction methods for treating distal radial fractures in adults. Cochrane Database of Systematic Reviews 2003, Issue 1
Health Research Classification System category	Injuries and Accidents

Extra information provided by this PSP
Original uncertainty examples	Who should reduce the fracture? ~ Is there any benefit to paramedics trying to reduce an obviously deformed wrist? ~ Should the ambulance crew reduce the deformity for analgesia? ~ Is splinting and/or reduction deemed adequate by upper limb specialists? ~ Is there a golden time frame in which it is recommended to reduce a dislocation, and by whom? ~ What is the best way to reduce a distal radius fracture in ED? ~ Is there a relationship between the time of fracture reduction and long term pain relief and hand functions?
Submitted by	32 x Healthcare Professionals, 12 x Patients, 3 x Carers / Relatives

Extra information provided by this PSP

Original uncertainty examples

Who should reduce the fracture? ~ Is there any benefit to paramedics trying to reduce an obviously deformed wrist? ~ Should the ambulance crew reduce the deformity for analgesia? ~ Is splinting and/or reduction deemed adequate by upper limb specialists? ~ Is there a golden time frame in which it is recommended to reduce a dislocation, and by whom? ~ What is the best way to reduce a distal radius fracture in ED? ~ Is there a relationship between the time of fracture reduction and long term pain relief and hand functions?

Submitted by

32 x Healthcare Professionals, 12 x Patients, 3 x Carers / Relatives

PSP information
PSP unique ID	0093
PSP name	Broken Bones of the Upper Limb in People over 50 PSP
Total number of uncertainties identified by this PSP.	50 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	3 December 2018