Pain Perception following Initial Closed Reduction in the Preoperative Care of Unstable, Dorsally Displaced Distal Radius Fractures

Abstract

Introduction Closed reduction and cast immobilization is a common practice as initial treatment for distal radius fractures. This study examines the pain perception that accompanies this approach. Materials and Methods Thirty dorsally displaced distal radius fractures were reduced and casted under finger-trap traction with intravenous analgesics. Patients rated their pain perception on visual analog scale prior to presentation, during reduction, during casting, and for every day until surgery. Closed reduction improved palmar tilt from −26.3 to −10.8 degrees. Surgery improved palmar tilt from −10.8 to +6.1 degrees. Closed reduction improved radial inclination from 15.5 to 19.1 degrees. Surgery improved radial inclination from 19.1 to 21.6 degrees. Mean pain perception was 5.8 at presentation. Reduction increased pain to 7.5 (p < 0.001), whereas casting was less painful (3.7; p < 0.001). At the evening following casting and the following days until surgery, mean pain was still as high as 4.1, 4.2, 4.1, 3.6, 3.9, 2.8, 3.0, and 3.0, with some patients experiencing more pain than initially. Conclusion Reduction generates significant pain with only minor relief during cast immobilization. The indication for closed reduction prior to cast application is therefore questionable.

Regional versus General Anesthesia in Postoperative Pain Management after Distal Radius Fracture Surgery: Meta-Analysis of Randomized Controlled Trials

“…Further research with larger sample sizes and diverse study settings is warranted to provide a more comprehensive understanding of this topic. In addition, treatment-related variables, including the time to surgery and initial closed reductions before surgery, and injury characteristics, such as open or closed fractures, could potentially influence postoperative pain level after distal radius fracture [33,34], but these potentially confounding variables were not addressed in this meta-analysis due to limitations in the available information from the included studies. Another limitation of this meta-analysis was the variability in the postoperative pain management protocols among the included trials.…”

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

“…and stress, but it also interferes with the success of the reduction. 5 Despite this, there are few studies that have reported a measure of patient-perceived pain during fracture reduction, [6][7][8][9][10][11][12][13] so that the best technique to control the pain has yet to be defined.…”

“…The pain perceived by the patient during the closed reduction of distal radius fractures can cause discomfort and stress, but it also interferes with the success of the reduction. 5 Despite this, there are few studies that have reported a measure of patient-perceived pain during fracture reduction, 6 7 8 9 10 11 12 13 so that the best technique to control the pain has yet to be defined.…”