Hematoma Block as an Alternate Mode of Anesthesia for Management of Extra-Articular Distal End Radius Fracture with...

Fractures of the distal end of the radius have a higher prevalence, particularly in older individuals, and typically necessitate a painful procedure of reduction by manipulation. Various regional blocks, including hematoma blocks, are used to manage this pain. Hematoma block is simple, effective, and safe, providing adequate analgesia without increasing post-procedural infection risks.

This prospective study was conducted to observe and analyze the outcomes of 18 patients, aged from 18 to 65 years, who had displaced fractures in the distal end of the radius. These fractures were treated using percutaneous pinning under a hematoma block. The study measured the time from trauma to surgery, time for hematoma block administration, surgery duration, Visual Analog Scale (VAS) scores for pain preoperatively, intraoperatively, and postoperatively, reduction quality, and functional outcome using Mayo Wrist score and complications if any.

The time from trauma to surgery was 31.44 ± 9.25 h. Hematoma block administration took 3.45 ± 1.34 min, and surgery duration was 29.16 ± 5.33 min. Pre-operative VAS was 6.39 ± 1.09, intraoperative VAS was 0.94 ± 0.54, and post-operative (3 h) VAS was 2.06 ± 0.80. The average pain-free duration postoperatively was 9.36 ± 3.21 h. Quality of reduction was excellent in 44.44% of cases and good in 38.89% of cases. Patients were discharged on average 4.19 ± 0.82 h after surgery. The functional outcome as noted by the Modified Mayo wrist score was excellent in 55.55% and poor in only 5.55% of cases.

The hematoma block demonstrated effective post-operative pain control, comparable to the brachial plexus block. It provided significant perioperative pain relief, reduced hospital stay, and allowed for outpatient or daycare surgery.

Hematoma block is a viable alternative for managing extra-articular distal end radius fractures in the emergency department, offering effective pain relief with minimal risk of complications. Further studies are needed to compare its efficacy with other anesthesia modalities.