Ultrasound-guided hematoma block and fracture reduction: a new way to go forward

Introduction

The conventional treatment for most distal radial fractures is closed reduction and cast immobilization. Conventionally the hematoma block is used to reduce the fractures but it is done blindly and radiographic techniques have been essential and effective in monitoring these reductions [1]. Radiation-free ultrasonography, however, can provide both real-time and dynamic multiple-plane images with a small and simple-to-use transducer that can be operated with only one hand. We therefore wanted to see whether the real-time and dynamic multiple-plane observation capabilities of ultrasonography would allow an ED physician to perform under direct vision a hematoma block and closed reduction without multiple attempts of either as are frequently required when only conventional techniques are used.

Methods

Sonographically guided hematoma block and closed reduction was performed in three patients in the emergency department for an acute distal radial fracture. The efficacy of this method was evaluated and compared with that of conventional techniques.

Results

The ultrasound images helped giving the hematoma block under direct vision and delineated the fractures as accurately as did the conventional radiographs. All parameters measured on the ultrasound images showed substantial restoration of anatomic alignment after reduction. Under direct vision, the hematoma block helped reduce the number of attempts and was less painful and achieved more patient satisfaction.

Conclusions

Sonography is an accurate, simple, time-saving, less painful and radiation-free tool. Reducing badly displaced or angulated forearm fractures in the emergency department can be difficult. Multiple attempts at reduction may be required, with repeated trips to the radiology department, before an adequate reduction is achieved [2]. Therefore ultrasound-guided hematoma block and reduction of difficult forearm fractures reduces the number of needle attempts and allows the physician to assess the adequacy of the reduction at the patient's bedside.