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Periosteal nerve blocks for distal radius and ulna fracture manipulation--the technique and early results.

Tageldin ME, Alrashid M, Khoriati AA, Gadikoppula S, Atkinson HD - J Orthop Surg Res (2015)

Bottom Line: The procedure was described as painless in 35 (83%) patients (visual analogue scale/VAS score 0), with 6 (14%) suffering minimal pain (VAS 1-3).No additional analgesia of any kind was given.Local anaesthetic periosteal nerve blocks injected proximally to the fracture sites are a simple and yet very effective new technique which provide good/excellent analgesia and facilitate the reduction of distal radial and ulnar fractures.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma and Orthopaedics, North Middlesex University Hospital, London, N18 1QX, UK. mohamed.tageldin@sky.com.

ABSTRACT

Background: We present a pilot series of patients with distal forearm fractures manipulated following a proximal periosteal nerve block with local anaesthesia. This is a novel technique which can be utilised in adults and children and is described herein.

Methods: With a median of 40 years (range 10-81 years), 42 patients (16 children) with distal radial and ulnar fractures were included. Of these patients, 40 underwent periosteal blocks in the emergency room or fracture clinic; 2 were already inpatients. Fractures were manipulated routinely and immobilised with plaster. Mobile fluoroscopy was not used for patients in the emergency department or fracture clinic.

Results: Of the 42 patients, 40 patients (95%) had successful fracture manipulation and did not require subsequent treatment. Two patients (5%) needed subsequent surgery, one for K-wire stabilisation of their fracture and the second for volar plate fixation. The procedure was described as painless in 35 (83%) patients (visual analogue scale/VAS score 0), with 6 (14%) suffering minimal pain (VAS 1-3). In the 12-16-year age group, 15 patients (94%) described the manipulation as painless; 1 patient described the procedure as minimally painful. No additional analgesia of any kind was given. There were no direct complications from any of the periosteal nerve blocks.

Conclusions: Local anaesthetic periosteal nerve blocks injected proximally to the fracture sites are a simple and yet very effective new technique which provide good/excellent analgesia and facilitate the reduction of distal radial and ulnar fractures.

No MeSH data available.


Related in: MedlinePlus

A schematic of the forearm showing the sensory nerve network from the posterior interosseous nerve flowing via the extensor pollicis longus muscle
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Fig3: A schematic of the forearm showing the sensory nerve network from the posterior interosseous nerve flowing via the extensor pollicis longus muscle

Mentions: The process is repeated for the ulna with approximately 3 ml of lidocaine solution if there is a concurrent ulnar fracture (regardless of whether or not the ulnar fracture is displaced). Figure 3 shows the periosteal nerve supply.Fig. 3


Periosteal nerve blocks for distal radius and ulna fracture manipulation--the technique and early results.

Tageldin ME, Alrashid M, Khoriati AA, Gadikoppula S, Atkinson HD - J Orthop Surg Res (2015)

A schematic of the forearm showing the sensory nerve network from the posterior interosseous nerve flowing via the extensor pollicis longus muscle
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4557923&req=5

Fig3: A schematic of the forearm showing the sensory nerve network from the posterior interosseous nerve flowing via the extensor pollicis longus muscle
Mentions: The process is repeated for the ulna with approximately 3 ml of lidocaine solution if there is a concurrent ulnar fracture (regardless of whether or not the ulnar fracture is displaced). Figure 3 shows the periosteal nerve supply.Fig. 3

Bottom Line: The procedure was described as painless in 35 (83%) patients (visual analogue scale/VAS score 0), with 6 (14%) suffering minimal pain (VAS 1-3).No additional analgesia of any kind was given.Local anaesthetic periosteal nerve blocks injected proximally to the fracture sites are a simple and yet very effective new technique which provide good/excellent analgesia and facilitate the reduction of distal radial and ulnar fractures.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma and Orthopaedics, North Middlesex University Hospital, London, N18 1QX, UK. mohamed.tageldin@sky.com.

ABSTRACT

Background: We present a pilot series of patients with distal forearm fractures manipulated following a proximal periosteal nerve block with local anaesthesia. This is a novel technique which can be utilised in adults and children and is described herein.

Methods: With a median of 40 years (range 10-81 years), 42 patients (16 children) with distal radial and ulnar fractures were included. Of these patients, 40 underwent periosteal blocks in the emergency room or fracture clinic; 2 were already inpatients. Fractures were manipulated routinely and immobilised with plaster. Mobile fluoroscopy was not used for patients in the emergency department or fracture clinic.

Results: Of the 42 patients, 40 patients (95%) had successful fracture manipulation and did not require subsequent treatment. Two patients (5%) needed subsequent surgery, one for K-wire stabilisation of their fracture and the second for volar plate fixation. The procedure was described as painless in 35 (83%) patients (visual analogue scale/VAS score 0), with 6 (14%) suffering minimal pain (VAS 1-3). In the 12-16-year age group, 15 patients (94%) described the manipulation as painless; 1 patient described the procedure as minimally painful. No additional analgesia of any kind was given. There were no direct complications from any of the periosteal nerve blocks.

Conclusions: Local anaesthetic periosteal nerve blocks injected proximally to the fracture sites are a simple and yet very effective new technique which provide good/excellent analgesia and facilitate the reduction of distal radial and ulnar fractures.

No MeSH data available.


Related in: MedlinePlus