Periosteal nerve blocks for distal radius and ulna fracture manipulation--the technique and early results.
We present a pilot series of patients with distal forearm fractures manipulated following a proximal periosteal nerve block with local anaesthesia. This is a novel technique which can be utilised in adults and children and is described herein.



With a median of 40 years (range 10-81 years), 42 patients (16 children) with distal radial and ulnar fractures were included. Of these patients, 40 underwent periosteal blocks in the emergency room or fracture clinic; 2 were already inpatients. Fractures were manipulated routinely and immobilised with plaster. Mobile fluoroscopy was not used for patients in the emergency department or fracture clinic.



Of the 42 patients, 40 patients (95%) had successful fracture manipulation and did not require subsequent treatment. Two patients (5%) needed subsequent surgery, one for K-wire stabilisation of their fracture and the second for volar plate fixation. The procedure was described as painless in 35 (83%) patients (visual analogue scale/VAS score 0), with 6 (14%) suffering minimal pain (VAS 1-3). In the 12-16-year age group, 15 patients (94%) described the manipulation as painless; 1 patient described the procedure as minimally painful. No additional analgesia of any kind was given. There were no direct complications from any of the periosteal nerve blocks.



Local anaesthetic periosteal nerve blocks injected proximally to the fracture sites are a simple and yet very effective new technique which provide good/excellent analgesia and facilitate the reduction of distal radial and ulnar fractures.
Department of Trauma and Orthopaedics, North Middlesex University Hospital, London, N18 1QX, UK. mtageldin2@gmail.com.
M Elhosseini
ME
Tageldin
Department of Trauma and Orthopaedics, North Middlesex University Hospital, London, N18 1QX, UK. mamunalrashid@hotmail.com.
Mamun
M
Alrashid
St George's Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, UK. alkhoriati@doctors.org.uk.
Al-Achraf
AA
Khoriati
Department of Trauma and Orthopaedics, North Middlesex University Hospital, London, N18 1QX, UK. srigadikoppula@googlemail.com.
Srinivas
S
Gadikoppula
Department of Trauma and Orthopaedics, North Middlesex University Hospital, London, N18 1QX, UK. dusch1@gmail.com.
Henry Dushan
HD
Atkinson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001340:Autonomic Nerve Block / Q000379:methods*; D002648:Child; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010521:Periosteum / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D055815:Young Adult