Koren Lior, Ginesin Eyal, Elias Shahem, Wollstein Ronit, Israelit Shlomo
Rambam Health Care Campus, Haifa, Israel.
The Technion-Israel Institute of Technology, School of Medicine, Haifa, Israel.
Plast Surg (Oakv). 2018 May;26(2):99-103. doi: 10.1177/2292550317740689. Epub 2017 Dec 18.
Distal radius fractures (DRFs) are treated in the emergency department (ED) with a closed reduction in order to decrease neurovascular and soft tissue injury and as a first definitive step in conservative treatment. The type of anesthesia used may affect the ability to reduce the fracture and remains controversial.
The purpose of this study was to compare the quality of radiographic reduction achieved in the ED of DRF reduced using sedation anesthesia to those reduced with hematoma block anesthesia.
A retrospective case-control study of 240 DRF reductions, 30 treated with sedation and 210 with a hematoma block, was performed. Complications and time spent in the ED were documented. Pre- and postreduction radiographs were reviewed for volar tilt, radial angulation, radial height, and ulnar variance.
Both groups were similar in gender, background illnesses, concomitant injuries, surgeon experience, and fracture radiographic classification. Postreduction values of volar tilt were better in the sedation group ( = .03). Volar tilt and ulnar variance improved more in the sedation group ( = .001). The sedation group spent more time in the ED ( = .001).
Sedation seemed to be more efficient than hematoma block in supporting closed reduction of distal radius fractures in the ED. However, this method requires specialized personnel and more time spent in the ED.
We suggest using this method when the patient is planned to continue with conservative treatment.
桡骨远端骨折（DRF）在急诊科进行闭合复位治疗，以减少神经血管和软组织损伤，并作为保守治疗的首要决定性步骤。所使用的麻醉类型可能会影响骨折复位的能力，目前仍存在争议。
本研究的目的是比较在急诊科使用镇静麻醉与血肿阻滞麻醉复位的桡骨远端骨折的影像学复位质量。
对240例桡骨远端骨折复位病例进行回顾性病例对照研究，其中30例采用镇静治疗，210例采用血肿阻滞治疗。记录并发症和在急诊科的停留时间。对复位前后的X线片进行掌倾角、桡偏角、桡骨高度和尺骨变异的评估。
两组在性别、基础疾病、合并损伤、外科医生经验和骨折影像学分类方面相似。镇静组复位后的掌倾角更好（P = 0.03）。镇静组的掌倾角和尺骨变异改善更明显（P = 0.001）。镇静组在急诊科停留的时间更长（P = 0.001）。
在急诊科支持桡骨远端骨折的闭合复位方面，镇静似乎比血肿阻滞更有效。然而，这种方法需要专业人员，并且在急诊科花费更多时间。
我们建议在计划对患者继续进行保守治疗时使用这种方法。
