Use of ultrasound for the management of distal radial fracture in the emergency department

Distal radius fracture is a pathology frequently seen in the emergency department (ED), with a prevalence of 9/10,000 and 37/10,000 in men and women over the age of 35 respectively. It represents about 16% of all fractures seen in the emergency department. A large percentage of these fractures can be appropriately managed with a closed reduction under local anesthesia within the emergency department. The two most commonly used methods being the blockage of the hematoma, or regional intravenous anesthesia (IVRA) known as Bier’s block. The NICE guidelines recommend the use of IVRA over haematoma block, since the blockade of the hematoma provides less analgesia and may compromise the reduction. The British Orthopaedic Association Standards for Trauma (BOAST) for distal radius fractures recommends Bier s block in favour of haematoma block. Most ED departments reduce these fractures under a haematoma block with a previous survey conducted in emergency departments England and Wales in which the most frequent anaesthetic types were haematoma block (50%), intravenous benzodiazepines (20%) and Bier’s block (17%) and this is a significant change in practice. This will need more training in the administration of regional anaesthesia and is going to be more time consuming, especially in the current NHS busy ED setting. At present, there is limited scientific evidence on the use of ultrasound for the reduction of distal radial fractures in the emergency department. As a result, this study was designed to assess whether the use of ultrasound could increase the percentage of successful reductions, in addition to improving the accuracy of analgesic block, thus reducing pain during reduction.