Haematoma block is the most efficient technique for closed forearm fracture reduction: a retrospective cohort study

The answer to some research questions are so glaringly obvious that they really don’t need to be studied.

Anyone who has done a haematoma block for a wrist fracture knows that they are a lot quicker and less resource intensive than a Bier’s block or procedural sedation. This is the major advantage of choosing a haematoma block over the other techniques.

Nevertheless, these researchers from Australia put the answer in black and white with this retrospective cohort study. Looking at the metric of ED length of stay (LOS), they proved that haematoma block was faster in their two ED’s. The mean ED LOS was 187 minutes for haematoma block, 227 minutes for Bier’s, and 239 minutes for procedural sedation.

I suspect that other ED’s might have more impressive differences if they have trouble accessing crowded resuscitation rooms and qualified staff that are busy with other tasks.

On the flip side, procedural sedation had a higher rate of successful first attempt reduction at 94% vs. 76% for haematoma block. But groups were not randomised and reductions under procedural sedation were twice as likely to have senior staff present and an orthopaedic registrar.

They also mention the cost of consumables and opportunity cost were less with haematoma block. No surprise here.

More patients had complications with procedural sedation 18%, Bier’s 14% and 13% with haematoma block. All but one of the complications of haematoma block were due to “block failure.” I don’t believe this to be a complication but rather an expected outcome. Sometimes haematoma blocks simply don’t work and one needs to proceed to plan B. No big deal.

In their conclusion, the authors state haematoma block “should be the default anaesthetic technique” for closed reduction of closed forearm fracture reductions. Obviously, the choice is multifactorial and comes down to patient and local institutional factors. But generally speaking, I agree.

Covering:

Pitman GR, Soeyland T, Popovic G, Thomson D. Haematoma block is the most efficient technique for closed forearm fracture reduction: a retrospective cohort study. Emerg Med J. 2024 Sep 25;41(10):595-601. doi: 10.1136/emermed-2023-213591. PMID: 39019579. [link to article]