Ultrasound-guided Hematoma Block for Distal Radial and Ulnar Fractures

Gottlieb, Michael; Cosby, Karen

doi:10.1016/j.jemermed.2014.09.063

Cited by 24 publications

(11 citation statements)

References 9 publications

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“…The protocol using the WALANT technique in our case series started with a hematoma block via a 3–5 ml 1% lidocaine injection from the dorsal site into the fracture site to minimize the discomfort due to sterilization and manipulation procedures for the fractured wrist [ 7 – 10 ]. Subcutaneous injection with 1% lidocaine mixed with 1:40000 epinephrine approximately 5–10 ml was administered directly onto the operative volar or dorsal region of the distal radius.…”

Section: Methodsmentioning

confidence: 99%

WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet

et al. 2018

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BackgroundThe wide-awake local anesthesia no tourniquet (WALANT) technique is applied during various hand surgeries. We investigated the perioperative variables and clinical outcomes of open reduction and internal fixation (ORIF) for distal radius fractures under WALANT.MethodsFrom January 2015 to January 2017, 60 patients with distal radius fractures were treated, and 24 patients (40% of all) were treated with either a volar or a dorsal plate via WALANT procedure. Of these 24 patients, 21 radius fractures were fixed with a volar plate, and the other 3 were fixed with a dorsal plate. Radiographs; range of motions; visual analog scale (VAS); quick disabilities of the arm, shoulder, and hand (Quick DASH) questionnaire; and time to union were evaluated.ResultsOne of the 24 patients could not tolerate the WALANT procedure and was reported as a failed attempt at WALANT. In the cohort, 23 patients successfully received distal radius ORIF under WALANT procedure. The average age is 60.9 (range, 20–88) years. The average operation time was 64.3 (range, 45–85) minutes, the average blood loss was 18.9 (range, 5–30) ml, and the average of duration of hospitalization is 1.8 (range, 1–6) days. The average postoperative day one VAS was 1.6 (range, 1–3). The average time of union was 20.7 (range, 15–32) weeks. The mean follow-up period was 15.1 (range, 12–24) months. Functional 1-year postoperative outcomes revealed an average Quick DASH score of 7.60 (range, 4.5–13.6) and an average wrist flexion and extension of 69.6° (range, 55–80°) and 57.4° (range, 45–70°). There was no wound infection, neurovascular injury, or other major complication noted.ConclusionsWALANT for distal radius fracture ORIF is a method to control blood loss by the effects of local anesthesia mixed with hemostatic agents. Without a tourniquet, the procedure prevents discomfort caused by tourniquet pain. Without sedation, patients could perform the active range of motion of the injured wrist to check if there is impingement of implants. It eliminates the need of numerous preoperative examinations, postoperative anesthesia recovery room care, and side effects of the sedation. However, patients who are not amenable to the awake procedure are contraindications.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0903-1) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet

et al. 2018

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“…Hemarthrosis is a hint for intraarticular injuries and can be easily observed by POCUS [ 14 , 15 ]. POCUS can be used to assist fracture reduction, determine realignment, and perform hematoma block [ 29 – 31 ]. In mass casualty incidents, POCUS for long bone fractures has been integrated in the ultrasound-assisted chest, abdomen, vena cava, and extremities for acute triage (CAVEAT) examination for triage [ 32 ].…”

Section: Long Bone Fracturementioning

confidence: 99%

An overview of point-of-care ultrasound for soft tissue and musculoskeletal applications in the emergency department

et al. 2016

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BackgroundThe skin, soft tissue, and most parts of the musculoskeletal system are relatively superficial anatomical structures and ideal targets for ultrasound examination in the emergency departments. Soft tissue and musculoskeletal ultrasound applications are relatively underused compared to traditional emergency applications, such as trauma, abdominal aortic aneurysm, and chest and cardiovascular systems.Main textIt is important to have knowledge about sonoanatomy and landmarks within the skin, soft tissue, and musculoskeletal systems. Portable machines equipped with high-resolution transducers are now available to fulfill this field of applications in many emergency departments. After needling practice, emergency physicians can not only diagnose and identify pathological findings but also provide interventional procedures and treatments. In this review, we will introduce point-of-care ultrasound (POCUS) applications regarding the soft tissue and musculoskeletal systems: soft tissue infections, joint effusions, foreign bodies, long bone fractures, muscle and tendon injuries, vascular occlusions, and procedures.ConclusionsWith POCUS, emergency physicians can visualize the structures beneath the skin and provide better and safer cares in the emergency departments.Electronic supplementary materialThe online version of this article (doi:10.1186/s40560-016-0173-0) contains supplementary material, which is available to authorized users.

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“…23 HB when compared with sedation, GA, brachial plexus block, etc., has been found to have greater patient acceptance and more efficient with regard to time and the resources required. 7,24,25 There has been renewed interest in HB as the technique is performed using of ultrasound for guidance and adjuncts for the HB. 18,25 Even though HB is safe, a case of osteomyelitis and a case of compartment syndrome have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…7,24,25 There has been renewed interest in HB as the technique is performed using of ultrasound for guidance and adjuncts for the HB. 18,25 Even though HB is safe, a case of osteomyelitis and a case of compartment syndrome have been reported. 26,27 In our study, not a single case of surgical site infection or osteomyelitis was noted during a 90-day follow-up of the cases.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of forearm fractures using a combination of haematoma block and intravenous regional anaesthesia

Verma

Hasnain

Sreevastava

et al. 2016

Medical Journal Armed Forces India

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m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 2 ( 2 0 1 6 ) 2 4 7 -2 5Methods: An observational case series was designed with the hypothesis that a combination of HB and IVRA would overcome the aforementioned drawbacks. A standardized protocol was followed for HB with 0.1 ml/kg of 0.5% bupivacaine preceding the conduct of IVRA, which permitted adequate exsanguination of the extremity (using compression bandage). For IVRA, 0.5% lignocaine at 3 mg/kg was used with an electro-pneumatic tourniquet. Pain scores were noted after the HB, at exsanguination and during surgery.Results: 100 cases were studied. Average time of onset of block after HB was 2 min 18 s. By the time the IVRA procedure was performed, 99% of patients had a pain score of zero. The quality of surgical anaesthesia revealed that 94% of the patients did not have any pain of incision, tourniquet or positioning at any time during surgery. Conclusion:The use of dual technique of HB and IVRA improved patient acceptance and compliance, and the safety and efficacy of the IVRA. The combination anaesthesia was found to be easy to administer, effective and safe with no complications. #

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Ultrasound-guided Hematoma Block for Distal Radial and Ulnar Fractures

Cited by 24 publications

References 9 publications

WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet

WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet

An overview of point-of-care ultrasound for soft tissue and musculoskeletal applications in the emergency department

Anaesthetic management of forearm fractures using a combination of haematoma block and intravenous regional anaesthesia

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