gms | German Medical Science

Objectives: Hematoma blocks (HB) have been used successfully in emergency departments (ED) for decades as an effective measure to reduce pain in order to perform closed reduction and casting after distal radius fractures. By transcutaneous injection of local anesthetic to the fracture hematoma, adequate analgesia can be obtained during different closed reduction maneuvers. The invasive manner of the procedure, which technically resembles the creation of an open fracture, yet still raises the question: Does HB lead to higher complication rates and a higher risk of infection, similar to those present in open fractures?

Methods: Over the course of 3 years we wanted to show the connection between HB after distal radius fractures and potential complications in a retrospective, mono-centric study. We included all patients older than the age of 18, who had presented to ED (in 2012, 2013 and 2014) with a traumatic distal radius fracture and who underwent some form of closed reduction in our ED. We excluded all patients who had received previous treatment elsewhere and who were in need of transfixation or immediate surgical treatment. All patients were followed up for complications until treatment was completed and patients were discharged from our outpatients clinic. Any re-visits over the following 3 years after the initial trauma were taken into consideration as well. Specifically we were looking at complications including post-surgical infections, osteomyelitis, complex regional pain syndrome and non-union fractures. We used a students t-test to compare the group receiving HB and the group receiving procedural anesthesia.

Results and conclusion: We screened 207 patients who presented to our ED with a distal radius fracture in the year of 2012. 94 patients were included in the study and 24 patients received a HB, versus 70 patients receiving procedural anesthesia (PA). We were able to show that there was no correlation between receiving HB or PA and any functional complication (p = 0,345). Moreover we were able to show that no patients receiving HB presented with any of the previously reported complications.

Currently we are extending the number of patients included in the study to the years of 2013 and 2014, so that our previous findings can be supported by a greater number of cases. In summery our data suggests no difference between receiving HB or PA and that HB is a safe and effective procedure in regards to closed reduction in distal radius fractures. The fear of creating open fractures through HB should therefore be critically questioned and we hope to help demystifying this long lasting myth through our forthcoming results.