Analgesic Techniques for Distal Radius Fracture Manipulation

Distal radius fractures (DRFs) are one of the most common orthopaedic injuries seen in the Accident and Emergency (A&E) Department, accounting for 17% of all fractures. They are associated with significant morbidity, with substantial economic and societal costs due to the high incidence of these injuries. Initial management of displaced fractures consists of prompt reduction of the fracture in A&E and application of a moulded plaster cast to hold the fracture. However, there is currently no consensus on the best anaesthetic to use during the manipulation procedure. The most frequently used are local anaesthetic techniques, namely haematoma block and Bier's block. Current UK guidelines recommend the use of intravenous local anaesthetic (Bier's block) for manipulation. However, surveys of national practice show significant variations in practice, with haematoma block being the most commonly used technique. This article summarises the current evidence regarding the anaesthetic techniques for performing wrist manipulations.