OBJECTIVES: Distal radius fractures are among the most common fractures. Ultrasound is gaining importance in the treatment of and as a tool to diagnose distal radius fractures, guide regional anaesthesia and support reductions. Our aim was to demonstrate safety, feasibility and outcome in patients with a distal radius fractures undergoing ultrasound-guided regional anaesthesia (UGRA) with ultrasound-guided reduction (UGR), as compared with procedural sedation for the reduction.METHODS: This retrospective cohort study was carried out in the emergency department of the University Hospital Basel (Switzerland) between February 2014 and October 2017. Adults with an isolated forearm fracture were eligible. The intervention group was treated with UGRA of the brachial plexus and subsequent ultrasound-assisted fracture reduction. Patients in the control group received usual care, which is blind fracture reduction with extension and immobilisation under procedural sedation. RESULTS: 71 patients were enrolled in the intervention group and 142 were to the control group. There was one (1.4%) complication (pneumothorax) in the UGR group. Twenty-five patients (35%) in the intervention group and 67 patients (47%) in the control group underwent surgery. The association between surgery and study group was not significant (p = 0.08). The patient's age was negatively associated with surgery (p <0.001). The association between surgery and study group was significant in patients ≥60 years (p = 0.035). CONCLUSION:The combination of ultrasound-guided regional anaesthesia and ultrasound-guided reduction of distal radius fractures is feasible. Safety was shown by 70 out of 71 cases of UGRA being without complication. Effectiveness regarding the necessity of subsequent operation was comparable to usual care; in patients over 60 it may be lower with UGR.

Background: To facilitate shoulder reduction and shorten time from shoulder dislocation to reduction, we started in 2014 a protocol for ultrasound-guided interscalene block (UGIB) in pure shoulder dislocation as well as dislocation with greater tuberosity fracture and dislocated shoulder arthroplasty. Methods: Within 30 month, patients with shoulder dislocation, dislocation-fracture or dislocated arthroplasty were enrolled for UGIB. Exclusion criteria were sensomotoric deficits, compromised circulation, and refusal by patient or surgeon, infection at the injection site or allergy to local anesthetics. A linear ultrasound probe was used to visualize injection of 9ml local anesthetics into the interscalene groove. In case of unavailability of an UGIB-trained interventionist, reduction was done under procedural sedation. Time between admission and post-reduction x-ray was registered. UGIB-and sedation-groups were compared. Results: We encountered 168 patients (m 124, f 44) with shoulder dislocation (147), dislocation-fracture (19) or dislocated shoulder arthroplasty (2). Forty five patients (mean age 54.4y; min 17.7; max 94.8) matched UGIB-criteria; 123 patients (mean age 43.7y; min 17.0; max 88.1) received procedural sedation. Time from admission to post reduction x-ray in the UGIB-group (MV 83min±62.4) was significantly shorter than in the PS-group (MV 129min±112.7). No block-related complications occurred. We got follow-up information from 42 UGIB-patients: 35 patients would opt again for UGIB, whereas 2 patients experienced the procedure as uncomfortable, 3old patients could not remember and 2 were deceased meanwhile. Conclusions: UGIB is a reliable, fast method for shoulder reduction in shoulder dislocation, dislocationfracture and dislocated shoulder arthroplasty. Patients benefit from the shortening between shoulder dislocation and reduction.