Abstract
BackgroundWe present a pilot series of patients with distal forearm fractures manipulated following a proximal periosteal nerve block with local anaesthesia.This is a novel technique which can be utilised in adults and children and is described herein.MethodsWith a median of 40 years (range 10–81 years), 42 patients (16 children) with distal radial and ulnar fractures were included. Of these patients, 40 underwent periosteal blocks in the emergency room or fracture clinic; 2 were already inpatients. Fractures were manipulated routinely and immobilised with plaster. Mobile fluoroscopy was not used for patients in the emergency department or fracture clinic.ResultsOf the 42 patients, 40 patients (95 %) had successful fracture manipulation and did not require subsequent treatment. Two patients (5 %) needed subsequent surgery, one for K-wire stabilisation of their fracture and the second for volar plate fixation. The procedure was described as painless in 35 (83 %) patients (visual analogue scale/VAS score 0), with 6 (14 %) suffering minimal pain (VAS 1–3). In the 12–16-year age group, 15 patients (94 %) described the manipulation as painless; 1 patient described the procedure as minimally painful. No additional analgesia of any kind was given. There were no direct complications from any of the periosteal nerve blocks.ConclusionsLocal anaesthetic periosteal nerve blocks injected proximally to the fracture sites are a simple and yet very effective new technique which provide good/excellent analgesia and facilitate the reduction of distal radial and ulnar fractures.
Highlights
Distal radius and ulna fractures are some of the most common bony injuries [1], with a reported UK annual adult incidence of 9/10,000 men, 37/10,000 women [2] and 16/1000 children [3]
Of the 42 patients, 37 patients were manipulated under periosteal block in the emergency department and went home the same day
Three patients were treated in the fracture clinic, having previously had inadequate reductions in the emergency department under a haematoma block
Summary
Distal radius and ulna fractures are some of the most common bony injuries [1], with a reported UK annual adult incidence of 9/10,000 men, 37/10,000 women [2] and 16/1000 children [3]. In adults, these fractures are usually treated in an outpatient setting; around 20 % (mainly elderly patients) require inpatient hospital management [2]. We present a pilot series of patients with distal forearm fractures manipulated following a proximal periosteal nerve block with local anaesthesia This is a novel technique which can be utilised in adults and children and is described
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