Is Hematoma block effective in reducing distal radius fractures in elderly patients presenting to the Accidents and Emergency Department?

Objective: To determine the efficacy of hematoma block in reducing distal radius fractures in terms of radiological correction and frequency of re manipulation. Methods: We conducted this descriptive study in Department of the Orthopedic Surgery Bolan Medical Complex Hospital(BMC) Quetta from 3rd January 2018 to 3rd June 2020.All patients with distal radius fractures fulfilling the inclusion criteria were manipulated and casted under hematoma block in emergency department. Fracture reduction was confirmed by measuring important radiological parameters on immediate post reduction radiographs and at weekly interval for six weeks. Radiographic reduction was graded as excellent, good, fair and poor as per modified Sarmiento criteria. Patients with unacceptable radiographic correction were re-manipulated. P value was calculated by using Chi-square test for determining significance between important proportions.(P value< 0.05 was considered significant). Results: The total number of patients in our study were 120. The mean age was 60.9±8 years(range 51 to 89 years).Female patients were 91(75.8) and male 29(24.1%).Majority(65.8%,n=79) of our patients had right sided fracture while left side fracture was noted in 41(34.1%) patients. Immediate post reduction radiographs revealed excellent outcome in 109(90.8%) patients and good in11(9.1%) patients and no re-manipulation or revision was needed. The percentage of re-manipulation rate was 1.6%(n=2) at one week as radiographic reduction was not acceptable (P value < 0.05). At final follow up at 6th week excellent and good radiographic reduction was noted in 106(88.3%) and 14(11.6%) patients respectively and no re-manipulation was documented (P value < 0.05).No complication was noted. Conclusion: Distal radius fractures in elderly patients treated with closed reduction and casting under hematoma block in emergency department achieved excellent radiographic reduction in majority of our patients. A very low re-manipulation rate was noted.