Haematoma block: a safe method for pre-surgical reduction of distal radius fractures
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(2020) 15:351
RESEARCH ARTICLE
Open Access
Haematoma block: a safe method for presurgical reduction of distal radius fractures Tazio Maleitzke1,4,5* , Fabian Plachel1, Florian Nima Fleckenstein2,5, Florian Wichlas3 and Serafeim Tsitsilonis1,4,5
Abstract Background: The 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. Methods: We 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. Results: Overall, 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). Conclusion: According to our data, the apprehensions that clinicians may have of creating open fractures through HB procedures, are unnecessary and may be abandoned confidently. Keywords: Distal radius fracture, Haematoma block, Local anaesthetic, Closed reduction
Background Distal radius fractures are the most common extremity bone fractures and account for approximately 18 and 25% of all elderly and youth fractures, respectively. The prevalence of distal radius fractures has been growing consistently in recent years and approximately 1.5% of accident and emergency department (A&E) visits are due to distal radius fractures [1–3]. In 1986, Knirk and Jupiter pointed out the importance of an anatomical reduction in their often cited article entitled ‘intra-articular * Correspondence: [email protected] 1 Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany 4 Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany Full list of author information is available at the end of the article
fractures of the distal end of the radius in young adults’ [4]. If a closed reduction is possible, adequate analgesia is crucial for the patient’s comfort, as well as for radiographic post-reduction results, including dorsal tilt, radial inclination and ulnar variance [5, 6].
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