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 evaluate the beneficial and harmful effects of an ultrasound-guided brachial plexus nerve block for patients with distal radius fracture managed with closed reduction compared to standard care of haematoma block.
Hypothesis
We hypothesise that using a brachial plexus nerve block for closed reduction of a distal radius fracture can reduce the need for subsequent surgery compared to standard care of a haematoma block. This is based on the hypothesis that the brachial plexus nerve block’s ability to provide muscle relaxation and complete pain relief during the closed reduction allows for better anatomical alignment of the fractured bone ends. Additionally, we hypothesise that a brachial plexus nerve block for closed reduction will lead to better functional outcomes and fewer complications than a haematoma block.
Furthermore, minimal pain and discomfort during the closed reduction procedure will improve patient satisfaction and quality of care.
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