Non-surgical treatment with closed reduction and immobilization using a splint or cast is the preferred approach for stable distal radius fractures, particularly in elderly patients. It is also the initial intervention for displaced fractures with a surgical indication before the procedure, aiming to reduce edema, manage pain, and prevent associated complications. However, the maneuvers required for bone reduction can cause significant pain, and there is still insufficient evidence to favor one anesthetic method over another. In recent years, there has been a trend toward utilizing local methods, such as hematoma block or ultrasound-guided supracondylar block of the radial nerve, due to their lower incidence of complications. Nonetheless, there are currently no studies comparing the efficacy of these two analgesic approaches.
This study aims to compare the analgesic effect of ultrasound-guided supracondylar block with that obtained through hematoma block in patients with distal radius fracture during closed reduction, using the Numeric Rating Scale. Additionally, it aims to compare the quality of the reduction through radiographic measures and assess the frequency of adverse events after the two interventions.
Patients over 18 years old with skeletal maturity evidenced in the initial radiographs.
Patients with a radiological diagnosis of distal radius fracture
Patients whose clinical condition is considered acute (duration of symptoms less than one week).
Patients who have an indication for closed reduction as a definitive or initial management of their distal radius fracture
• Patients with bilateral distal radius fractures
Patients with open distal radius fractures.
Patients with another fracture in the same limb
Patients in a state of intoxication or under the influence of psychoactive substances.
Parallel
ultrasound-guided supracondylar block of the radial nerve
Procedure/Surgery75 mg of intramuscular diclofenac will be administered, or 1 gram of oral acetaminophen in case of contraindications for the administration of Non-Steroidal Anti-inflammatory Drugs
hematoma block
Procedure/SurgeryThe orthopedic surgeon will perform a hematoma block before closed reduction. Intramuscular diclofenac (75 mg) or oral acetaminophen (1 g) will be administered if NSAIDs are contraindicated. With the patient in a supine position, the fracture site will be identified through palpation. After antisepsis with 2% chlorhexidine gluconate, a 10 cc syringe with a 21-gauge needle will be inserted to aspirate and confirm placement over the fracture hematoma. Then, 1% lidocaine (2 mg/kg) without epinephrine will be infiltrated. A 10-minute waiting period will be observed before performing closed reduction maneuvers.
5 mg of intramuscular diclofenac
Drugthe orthopedic surgeon on duty will perform the hematoma block prior to closed reduction in the procedure room as follows: 75 mg of intramuscular diclofenac will be administered
Pain during closed
Pain experienced during the closed reduction of the distal radius fracture, measured by the numeric pain scale and reported immediately after the reduction maneuvers
Pain reduction after the analgesic procedure
Proportion of patients experiencing a reduction greater than two points (which corresponds to the minimal clinically important difference) between baseline pain and pain experienced after the analgesic procedure. the escale use is Visual Analogue Scale. It consists of a horizontal line of 10 cm (or 100 mm), where one end represents "no pain" (0) and the other end "the worst pain imaginable" (10 or 100, depending on the scale used). The higher the scale value, the worse the patient's health condition and the greater the pain.
Pain reduction measured after the closed reduction
proportion of patients experiencing a reduction greater than two points (which corresponds to the minimal clinically important difference) between baseline pain and during the closed reduction of the fracture
quality of reduction measured by dorsal tilt
in a lateral x-ray wrist projection, dorsal tilt is the angle formed between a line drawn between the most distal points of the dorsal and palmar lips of the distal radius and a line perpendicular to the axis of the radius. This measurement is important as its value is directly associated with the functional position of the wrist and its extension capacity. Its alteration is related to a dorsal displacement of the contact surface between the radius, scaphoid, and lunate, causing an abnormal increase in joint pressure and dysfunction of radiocarpal stability. It has been established that a volar tilt of less than 3° after reduction is inadequate.
quality of reduction measured by radial inclination
In a posteroanterior x-ray wrist projection, radial inclination is the angle between a line drawn from the styloid tip to the lunate facet of the radius and a line perpendicular to the axial axis of the radius. Its normal value i son average 21 to 25 degrees.
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Hospital Universitario San Ignacio
Lead sponsor
Pontificia Universidad Javeriana
Collaborator
