Circumferential periosteal block versus hematoma block for the reduction of distal radius and ulna fractures: a randomized controlled trial

Abstract

Purpose To assess the analgesic efficacy of the circumferential periosteal block (CPB) and compare it with the conventional fracture hematoma block (HB). Methods This study was a prospective single-center randomized controlled trial performed in a national orthopedic hospital. Fifty patients with displaced distal radius (with or without concomitant ulna) fractures requiring reduction were randomized to receive either CPB or HB prior to the reduction. Pain was sequentially measured using the visual analogue scale (VAS) across three stages; before administration of local anesthesia (baseline), during administration (injection) and during manipulation and immobilization (manipulation). Further, the effect of demographic factors on the severity of pain was analyzed in multivariate regression. Finally, complications and end outcomes were compared across both techniques. Results Patients receiving CPB experienced significantly less pain scores during manipulation (VAS = 0.64) compared with HB (VAS = 2.44) (p = < 0.0001). There were no significant differences between groups at baseline (P = 0.55) and injection (P = 0.40) stages. Conclusion The CPB provides a superior analgesic effect over the conventional HB with no documented complications in either technique. Level of evidence Therapeutic Level II.

The Hematoma Block versus Hematoma Plus Wrist Nerve Block in the Reduction of Distal Radius Fractures

“…There seems to be a wide variety of pain perception during fracture manipulation under hematoma block, with a mean score ranging from 0.9 to 5.5 points on the VAS. 11 13 23 Our results were consistent with the previously published data as the perceived pain at the wrist during fracture manipulation under hematoma block was 5.1 in the isolated hematoma block group and 4.6 in the hematoma plus a nerve block group. This pain reduction at the wrist may not be clinically significant.…”

“…On the other hand, a VAS score of 5 points for pain seems too high to consider the technique ideal. Furthermore, the wide variety of pain perception using the hematoma block 11 13 23 leads us to believe that the technique is not entirely reproducible or that, depending on the training, it is performed differently in each center, using different anesthetics, waiting different times until the reduction is performed or performing the traction and reduction in a different way. These details make it difficult to compare the results between the different published studies and draw relevant conclusions.…”

“Does Hook Type Matter in Articular Distal Radius Fixation? Re. Does Construct Type Matter? A Retrospective Review Comparing Outcomes of Distal Radius Fractures Treated with Standard Volar Plating versus Fragment-specific Fixation”

“…It seems radiologically obvious that reoperation to remove the material will be necessary after consolidation, at the risk of damaging the soft tissues. 3…”