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Periosteal nerve blocks for distal radius and ulna fracture manipulation--the
technique and early results
#MMPMID26328789
Tageldin ME
; Alrashid M
; Khoriati AA
; Gadikoppula S
; Atkinson HD
J Orthop Surg Res
2015[Sep]; 10
(?): 134
PMID26328789
show ga
BACKGROUND: We present a pilot series of patients with distal forearm fractures
manipulated following a proximal periosteal nerve block with local anaesthesia.
This is a novel technique which can be utilised in adults and children and is
described herein. METHODS: With a median of 40 years (range 10-81 years), 42
patients (16 children) with distal radial and ulnar fractures were included. Of
these patients, 40 underwent periosteal blocks in the emergency room or fracture
clinic; 2 were already inpatients. Fractures were manipulated routinely and
immobilised with plaster. Mobile fluoroscopy was not used for patients in the
emergency department or fracture clinic. RESULTS: Of the 42 patients, 40 patients
(95%) had successful fracture manipulation and did not require subsequent
treatment. Two patients (5%) needed subsequent surgery, one for K-wire
stabilisation of their fracture and the second for volar plate fixation. The
procedure was described as painless in 35 (83%) patients (visual analogue
scale/VAS score 0), with 6 (14%) suffering minimal pain (VAS 1-3). In the
12-16-year age group, 15 patients (94%) described the manipulation as painless; 1
patient described the procedure as minimally painful. No additional analgesia of
any kind was given. There were no direct complications from any of the periosteal
nerve blocks. CONCLUSIONS: Local anaesthetic periosteal nerve blocks injected
proximally to the fracture sites are a simple and yet very effective new
technique which provide good/excellent analgesia and facilitate the reduction of
distal radial and ulnar fractures.
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