None listed
Conditions
Brief summary
Distal radius fractures are one of the most commonly encountered fractures in Emergency Medicine. Anaesthesia is typically required prior to manipulation of displaced fractures. Providers desire a technique that has a low risk of systemic side effects, is easy to learn and administer, and provides excellent anaesthesia. Recently Tageldin published a series of 42 patients who underwent a manipulation using a novel technique called the periosteal block. Using this technique anaesthetic is injected proximal to the fracture site in a ring around the bone. No patients in this observational study experience complications. Following the block 83% of patients reported manipulation was painless and 14% reported only minimal pain. The skill of learning these blocks was easy to acquire, and they were performed successfully by junior and senior members of the orthopaedic team. This is a single centre, prospective, randomized clinical trial with consecutive recruitment of adult patients (16 years of age or older) presenting to the Dunedin Emergency Department with a distal radius fracture requiring manipulation. Consecutive patients with distal radius fractures deemed by the ED clinician to require closed reduction in the Emergency Department are eligible for enrollment. The hypothesis of the study is: Periosteal block performed by emergency physicians after brief training provides equivalent anaesthesia compared to IVRA during distal radius fracture manipulation.
Interventions
This is a single centre, prospective, randomized clinical trial with consecutive recruitment of adult patients (greater than or equal to 16 years) presenting to the Dunedin Emergency Department with a distal radius fracture requiring manipulation.
Study Setting: Single Emergency Department Emergency Department Providers will undergo brief training in Periosteal Block (Arm 1) and IVRA (arm 2) for distal radius fractures. Training will be provided by study investigators. The procedure will be
This is a single centre, prospective, randomized clinical trial with consecutive recruitment of adult patients (greater than or equal to 16 years) presenting to the Dunedin Emergency Department with a distal radius fracture requiring manipulation. Study Setting: Single Emergency Department Emergency Department Providers will undergo brief training in Periosteal Block (Arm 1) and IVRA (arm 2) for distal radius fractures. Training will be provided by study investigators. The procedure will be administered by the treating emergency physician. Arm 1: Periosteal block will be performed by treating ED physicians. The block will be performed with an injection of 15ml of 1% lidocaine Arm 2:IVRA (aka Biers Block) Performed using 3 ml/kg 0.5% Prilocaine
Sponsors
University of Otago
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients 16 years or older with a distal radius fracture undergoing closed reduction in the Emergency Department are eligible. This will include fractures where closed reduction is performed as definitive management and cases in which reduction is performed in the ED prior to definitive operative reduction and fixation.
Exclusion criteria
Exclusion Criteria: Open fractures, patients unable to provide consent, evidence of compartment syndrome, lignocaine or local anaesthetic allergy, history of sickle cell disease or Raynauds, patients with severe distracting injury, severe peripheral vascular disease, systolic BP >200, severe hepatic failure, or need for bilateral manipulation.
Outcome results
None listed