Abstract
BackgroundThe haematoma block (HB) has been successfully used to minimise pain prior to otherwise painful closed reduction manoeuvres for distal radius fractures. However, the invasive manner of the procedure, which technically produces an open fracture, still raises the question, whether HBs increase the risk of infection compared to conventional intravenous analgesia (IA). The purpose of this study was to assess complication rates and safety of the HB procedure for the closed reduction of surgically treated distal radius fractures.MethodsWe included 176 distal radius fractures in 170 patients in a retrospective mono-centric study, who underwent closed reduction and casting followed by definitive surgical care over a period of two years. Patients either received a HB or IA before closed reduction and were evaluated for minor and major complications over a follow-up period of four years.ResultsOverall, 42 distal radius fractures were treated with a HB (23.9%) and 134 with IA (76.1%) before closed reduction. There were a single major (2.3%) and eight minor (19%) complications observed in the HB group compared to two major (1.4%) and 24 minor (17.9%) complications in the IA group. No significant differences were identified between the two groups. Sex and type of fracture had no effect on complication rates, however, younger patients experienced higher complication rates in comparison to older ones (p = 0.035).ConclusionAccording to our data, the apprehensions that clinicians may have of creating open fractures through HB procedures, are unnecessary and may be abandoned confidently.
Highlights
The haematoma block (HB) has been successfully used to minimise pain prior to otherwise painful closed reduction manoeuvres for distal radius fractures
Our study population consisted of 176 distal radius fractures in 170 patients, of which 42 fractures were treated with a HB (23.9%) (10 mL prilocain 2% (20 mg/mL), Astra Zeneca GmbH, Wedel, Germany) and 134 with intravenous analgesia (IA) (76.1%) (7.5-15 mg of piritramide, Hameln Pharma Plus GmbH, Hameln, Germany) before closed reduction and casting in our A&E
There was no significant difference in the distribution of major complications between the HB and IA group, as shown in Table 2 (CVC = 0.029, p = 0.698)
Summary
The haematoma block (HB) has been successfully used to minimise pain prior to otherwise painful closed reduction manoeuvres for distal radius fractures. The purpose of this study was to assess complication rates and safety of the HB procedure for the closed reduction of surgically treated distal radius fractures. As an alternative to time- and staff-consuming general anaesthesia, a transcutaneous injection of local anaesthetic into the fracture haematoma, known as a HB, is commonly used in A&Es for closed reduction manoeuvres. HBs are widely used to alleviate pain during closed reductions of distal radius fractures, some A&E physicians remain apprehensive about performing. Since the needle used to instil the local anaesthetic creates a passage between the outside world and the internal fracture environment, this passage could in theory result in introducing an infection to the fracture site [7,8,9]. Whilst there have been studies reporting adverse events associated with HBs, namely, osteomyelitis and seizures [10,11,12], other studies could not confirm such complications [6, 13, 14]
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