Use and efficacy of haematoma blocks in managing closed reduction of distal radial fractures by emergency nurse practitioners: A matched case-control study design.

BACKGROUND

Displaced distal radial fractures are common among all age groups, but increasingly in older patients, and are frequently managed by emergency nurse practitioners. Most can be manipulated and reduced in the emergency department, often by procedural sedation and analgesia, which can be time consuming and often requiring multiple resources. Using haematoma blocks may offer advantages.

AIM: To examine the use and efficacy of haematoma blocks in managing close reduction of distal radial fractures by emergency nursing practitioners compared to procedural sedation.

DESIGN

Matched case-control study.

RESULTS

Compared to those who had procedural sedation and analgesia (n = 100), the haematoma block group (n = 100) had a shorter procedure time (0.4 hrs vs. 0.7 hrs, Z= -1.24, p < .001), time from reduction to discharge (1.5 hrs vs. 4.6 hrs, Z= -2.98, p < .001), overall ED length of stay (2.8 hrs vs. 4.9 hrs, Z= -3.49, p < .001) and minimal pain post reduction (0/10 vs. 4/10, Z= -2.6, p = .001). No adverse events were noted in the haematoma block group compared to 23 % in the procedural sedation and analgesia group.

CONCLUSION

Hematoma block is a safe, effective and efficient alternative to procedural sedation in the reduction of distal radial fractures by emergency nurse practitioners.