PMID- 36239973
OWN - NLM
STAT- MEDLINE
DCOM- 20230502
LR  - 20240502
IS  - 1478-7083 (Electronic)
IS  - 0035-8843 (Print)
IS  - 0035-8843 (Linking)
VI  - 105
IP  - 5
DP  - 2023 May
TI  - Manipulation of distal radius fractures: a comparison of Bier's block vs 
      haematoma block.
PG  - 434-440
LID - 10.1308/rcsann.2022.0116 [doi]
AB  - INTRODUCTION: Displaced distal radius fractures often require manipulation under 
      anaesthesia. Many anaesthetic techniques are described, with the two most 
      commonly used being Bier's block (BB) and haematoma block (HB). Despite national 
      guidance preferring a BB, an HB is often performed instead. This study aims to 
      compare the analgesic properties of a BB with those of an HB when manipulating 
      distal radius fractures. METHODS: This is an observational cohort study comparing 
      the management of displaced distal radius fractures requiring reduction across 
      two National Health Service trusts. Patients aged over 18 with isolated, 
      displaced distal radius fractures were recruited. Patient demographics, AO 
      fracture classification and grade of clinician performing the procedure were 
      recorded. A numeric rating scale (NRS) pain score was obtained for each patient 
      after manipulation. The quality of reduction was judged against standardised 
      anatomical parameters. RESULTS: Some 200 patients were recruited (100 HB, 100 
      BB). There were no differences in age (BB: median 66.5 years, interquartile range 
      [IQR] 55-74; HB: median 67 years, IQR 55-74; p = 0.79) or fracture 
      characteristics (p = 0.29) between cohorts. Patients undergoing BB had 
      significantly lower pain scores with a lower IQR than those undergoing HB (p < 
      0.005). Patients undergoing BB manipulation were more likely to have the fracture 
      reduced and normal anatomy restored (p < 0.005). BBs were performed mainly by 
      Foundation Year 2 junior doctors, whereas HB manipulations were performed by a 
      range of clinicians from emergency nurse practitioners to consultants. 
      CONCLUSIONS: BB provides better analgesia than an HB. This can be performed 
      successfully and reliably by Senior House Officer-level junior doctors.
FAU - Oakley, B
AU  - Oakley B
AD  - Nottingham University Hospitals NHS Trust, UK.
FAU - Busby, C
AU  - Busby C
AD  - Sherwood Forest Hospitals NHS Foundation Trust, UK.
FAU - Kulkarni, S
AU  - Kulkarni S
AD  - Sherwood Forest Hospitals NHS Foundation Trust, UK.
FAU - Arnold, S J
AU  - Arnold SJ
AD  - Nottingham University Hospitals NHS Trust, UK.
FAU - Kulkarni, S S
AU  - Kulkarni SS
AD  - Sherwood Forest Hospitals NHS Foundation Trust, UK.
FAU - Ollivere, B J
AU  - Ollivere BJ
AD  - Nottingham University Hospitals NHS Trust, UK.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20221014
PL  - England
TA  - Ann R Coll Surg Engl
JT  - Annals of the Royal College of Surgeons of England
JID - 7506860
SB  - IM
MH  - Humans
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - *Radius Fractures/surgery
MH  - *Wrist Fractures
MH  - State Medicine
MH  - Anesthesia, Local
MH  - Pain
MH  - Hematoma
PMC - PMC10149229
OTO - NOTNLM
OT  - Closed fracture reduction
OT  - Local anaesthetics
OT  - Nerve block
OT  - Radius fractures
OT  - Trauma
EDAT- 2022/10/15 06:00
MHDA- 2023/05/02 06:42
PMCR- 2024/05/01
CRDT- 2022/10/14 11:34
PHST- 2023/05/02 06:42 [medline]
PHST- 2022/10/15 06:00 [pubmed]
PHST- 2022/10/14 11:34 [entrez]
PHST- 2024/05/01 00:00 [pmc-release]
AID - rcsann.2022.0116 [pii]
AID - 10.1308/rcsann.2022.0116 [doi]
PST - ppublish
SO  - Ann R Coll Surg Engl. 2023 May;105(5):434-440. doi: 10.1308/rcsann.2022.0116. 
      Epub 2022 Oct 14.