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Ulnar Nerve Versus Hematoma Block for Closed Reduction of Boxer's Fractures
Terence Kwan-Wong, MD; Jaret L. Olson, MD
University of Alberta, Edmonton, AB, Canada
Introduction: To date, there is no published literature comparing methods for providing analgesia during closed reduction of transverse fifth metacarpal neck fractures. This study aims to determine whether ulnar nerve or hematoma blocks provide better analgesia when performing closed reduction of Boxer’s fractures.
Materials & Methods: A prospective randomized controlled trial of 24 patients with isolated displaced fifth metacarpal neck fractures was conducted. Using sealed and coded envelopes, patients were randomly allocated to receive either ulnar nerve (n=12) or hematoma (n=12) blocks. 5cc’s of local anesthetic (9:1 mixture of 1% plain lidocaine and 8.4% sodium bicarbonate) was administered as an ulnar nerve or hematoma block. After 10 minutes, cutaneous anaesthesia over the fracture site was checked, injecting additional local anesthetic if needed. Closed reduction was then performed using Jahss’ manoeuvre. Pain of injection and closed reduction were subsequently rated by patients using the NRS-11 pain scale.
Results: There was no statistically significant difference in demographics or injury characteristics between experimental groups. The amount of local anesthetic needed to achieve anesthesia prior to reduction was not statistically different between ulnar nerve and hematoma block groups. Pain of injection was similar between groups. Patients experienced less pain during closed reduction following ulnar nerve blocks compared to hematoma blocks (4.33 vs. 6.83, p=0.03). One patient undergoing an ulnar nerve block had inadvertent arterial puncture that resolved without complication; however, there was no statistically significant difference in total complication rates between block groups.
Conclusion: Ulnar nerve blocks provide better analgesia than hematoma blocks for closed reduction of Boxer’s fractures. The two blocks are comparable in terms of patient discomfort during injection, total volume of local anesthetic required, and complication rates.
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