title: The hematoma block: a simple, effective technique for closed reduction of ankle fracture dislocations.
abstract: Management of a dislocated ankle fracture can be challenging because of instability of the ankle mortise, a compromised soft tissue envelope, and the potential neurovascular compromise. Every effort should be made to quickly and efficiently relocate the disrupted ankle joint. Within the emergency department setting, narcotics and benzodiazepines can be used to sedate the patient before attempting closed reduction. The combination of narcotics and benzodiazepines provides relief of pain and muscle guarding; however, it conveys a risk of seizure as well as respiratory arrest. An alternative to conscious sedation is the hematoma block, or an intra-articular local anesthetic injection in the ankle joint and the associated fracture hematoma. The hematoma block offers a comparable amount of analgesia to conscious sedation without the additional cardiovascular risk, hospital cost, and procedure time.
authors.affiliation: Division of Foot and Ankle Surgery, Western Pennsylvania Hospital, Pittsburgh, PA 15224, USA.
authors.forename: Adrianne
authors.initials: A
authors.lastname: Ross
authors.forename: Alan R
authors.initials: AR
authors.lastname: Catanzariti
authors.forename: Robert W
authors.initials: RW
authors.lastname: Mendicino
mesh_terms: D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D016512:Ankle Injuries / Q000175:diagnosis / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007270:Injections, Intra-Articular; D004204:Joint Dislocations / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local