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A retrospective mono-centric study was carried out to determine the safety and complication rates of HB for closed reduction of surgically managed distal radius fractures.
For distal radius fractures, the haematoma block (HB) is effectively utilized to yield pain relief before a painful closed reduction manoeuvres. But, the invasive approach of the procedure is still debatable regarding the use of HB in increasing the infection risk than standard analgesia.
As per the outcomes of this study, the complication rates did not vary amongst
HB and standard analgesia treated patients. Also, more complications were
witnessed in younger patients after distal radius fractures.
A retrospective mono-centric study was carried
out to determine the safety and complication rates of HB for closed reduction
of surgically managed distal radius fractures.
Overall, 176 distal radius fractures in 170 subjects who underwent casting and closed reduction were incorporated in this analysis. They had definitive surgical care over 2 years. The patients were either given an HB (transcutaneous injection of local anaesthetic into the fracture haematoma) or intravenous analgesia (IA) prior to the closed reduction.
For the HB, about 10 ml of local anaesthetic, 2% prilocain (20 mg/ml) was efficiently drawn up into a sterile syringe. The site of fracture was recognized by the palpation of the dorsal wrist. Using a disinfecting solution, the dorsal wrist was suitably sterilized and draped. Transcutaneous insertion of the needle into the fracture area at a 30° angle was done.
The accurate location of the needle was validated by utilizing a C-arm image intensifier. This was followed by aspiration of the fracture haematoma. About 5-10 ml of prilocain was then appropriately infused into the fracture haematoma itself and into the superficial sensory branch of the radial nerve, as depicted in the following figure:
Participants were then examined for minor and
major issues over a 4 years follow-up.
All in all, 42 (23.9%) and 134 (76.1%) distal radius fractures were treated via the HB and IA. The number of complications has been portrayed in the following table:
Although gender and fracture type did not affect the complication rates. But, younger patients were found to have a higher complication rate than older (p = 0.035).
The hesitation concerning
clinicians regarding creating an open distal radius fracture from a closed distal radius fracture cannot be sustained. It has greater complication
rates and should be abandoned.
Journal of Orthopaedic Surgery and Research
Haematoma block: a safe method for pre-surgical reduction of distal radius fractures
Tazio Maleitzke et al.
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