Improving treatment for patients with acute wrist fractures
A national multicentre randomised controlled trial
Background
Distal radius fractures (DRF) are among the most common fractures worldwide. It affects over 14000 adults in Denmark annually, with numbers increasing due to an ageing population. DRFs may cause chronic pain, loss of hand function, and reduced work productivity, imposing a significant socioeconomic burden.
The majority of patients with DRFs are treated with non-surgical realignment (closed reduction) followed by immobilisation in a cast. However, approximately 30% subsequently undergo surgery because of unacceptable fracture realignment after closed reduction.
The haematoma block, defined as a local anaesthetic injected into the fracture site, is a commonly used standard care analgesic for closed reduction but is suboptimal for pain management during closed reduction. A brachial plexus nerve block, such as the lateral infraclavicular (LIC) brachial plexus block or the axillary (AXIL) brachial plexus block, induces both muscular relaxation and blocks pain transmission from the distal two-thirds of the arm. It may therefore be possible to perform the closed reduction without pain or muscular resistance.
Purpose
The purpose of this trial is to assess the benefits and harms of an ultrasound-guided plexus brachialis block for adult non-frail patients with DRF undergoing initial closed reduction compared with standard care.
Hypothesis
We hypothesise that superior pain relief and muscle relaxation of the forearm achieved by an ultrasound-guided brachial plexus block provides optimal conditions for closed reduction and casting of DRFs. This may result in better anatomical alignment of the fracture, ultimately translating into fewer surgeries and a better functional outcome compared to standard care. Furthermore, minimal pain and discomfort during the closed reduction procedure will improve patient satisfaction and quality of care.
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