Hematoma Block for Distal Radius Fracture

Hematoma blocks are safe and effective in providing analgesia for fracture reduction1-4. They
involve injecting lidocaine directly into the fracture line for analgesia. The physician
aspirates blood prior to injection to confirm placement in the hematoma created by the
fracture. However, the procedure can be technically difficult if the fracture line is
difficult to palpate, for example, due to significant swelling or body habitus. Ultrasound
has been shown to improve efficacy in other analgesic procedures such as peripheral nerve
blocks5 and also in identifying fracture lines6. There have been case reports and case series
which have shown the feasibility and effectiveness of ultrasound guided hematoma blocks for
analgesia in patients undergoing reduction for distal radius fractures7,8. To our knowledge
there are no randomized controlled trials comparing the use of ultrasound guided hematoma
blocks versus traditional hematoma blocks in achieving analgesia for distal radius fracture
reduction.

In this study, we will determine if ultrasound improves the efficacy of analgesia when
performing hematoma blocks for reduction of distal radius fractures.

Inclusion Criteria:

- Adult patient ≥ 18 years old presenting to the emergency department with complaint of
distal radius fracture

Exclusion Criteria:

- High acuity/distress per the Attending ED physician

- Altered mental status or intoxication

- Aphasia, mental retardation, dementia, or insurmountable communication barrier

- Acute psychiatric illness