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Periosteal nerve blocks for distal radius and ulna fracture manipulation--the technique and early results
M Elhosseini Tageldin1, Mamun Alrashid2, Al-Achraf Khoriati3
1Department of Trauma and Orthopaedics, North Middlesex University Hospital, London, N18 1QX, UK. mtageldin2@gmail.com.
Insights
A novel proximal periosteal nerve block using local anesthesia effectively manages distal forearm fractures in adults and children, providing excellent pain relief and successful manipulation in most cases.
Area of Science:
- Orthopedic Surgery
- Pain Management
- Anesthesiology
Background:
- Distal forearm fractures are common injuries in both pediatric and adult populations.
- Current manipulation techniques may cause significant pain and require additional analgesia.
- A novel approach using proximal periosteal nerve blocks for fracture manipulation is explored.
Purpose of the Study:
- To evaluate the efficacy and safety of proximal periosteal nerve blocks for manipulating distal radial and ulnar fractures.
- To assess patient-reported pain levels and the need for subsequent interventions.
Main Methods:
- A pilot series included 42 patients (16 children) with distal radius and ulnar fractures.
- Proximal periosteal nerve blocks with local anesthesia were administered prior to fracture manipulation.
- Fractures were manipulated and immobilized with plaster; mobile fluoroscopy was not used in the emergency department or fracture clinic.
Main Results:
- 95% of patients (40/42) achieved successful fracture manipulation without requiring further treatment.
- 83% of patients reported no pain (VAS 0), and 14% reported minimal pain (VAS 1-3).
- No direct complications related to the periosteal nerve blocks were observed.
Conclusions:
- Proximal periosteal nerve blocks are a simple, effective technique for analgesia and reduction of distal radial and ulnar fractures.
- This method offers good to excellent pain relief and facilitates fracture manipulation in a majority of patients.
- The technique is suitable for both adult and pediatric patients, with a high success rate and minimal complications.
Background:
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 herein.
Methods:
With 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.
Results:
Of 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.
Conclusions:
Local 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.
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