Wan Ali Wan Assanul Afzan, Soh Elaine Zi Fan, Abdullah Shalimar, Narin Singh Parminder Singh Gill, Ahmad Amir Adham, Sapuan Jamari
Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS.
Cureus. 2021 Jan 13;13(1):e12691. doi: 10.7759/cureus.12691.
Introduction Closed reduction is an effective method of treatment for distal end radius fractures. We present a case series of patients with distal end radius fractures who underwent closed manipulative reduction using the periosteal block. We describe the technique in detail and examine its efficacy in pain lowering effect during closed reduction. Methods Nineteen patients with distal end radial and ulnar fractures were included and grouped based on the Frykman classification. The reduction was performed using a periosteal block of 10 ml of 2% lignocaine injection. The severity of pain was recorded by utilizing the visual analog scale (VAS) in five phases: 1) before injection, 2) after 15 minutes of analgesia in a resting position, 3) during minimal motion, 4) during full manipulation and reduction, and 5) post-procedure. The VAS scoring was classified as painless (VAS score of 0), mild pain (VAS score between 1-3), and painful (VAS score of 4 and above). Results The study included 19 patients [median age of 53 years (range: 18-88 years)]; there were 11 (58%) males and eight (42%) females. The mechanism of injury was a fall (n=12, 63%) or a motor vehicle accident (n=7, 37%). There was a statistically significant reduction of pain between phase one and all the other phases. Between the different fracture configurations, there was no significant difference in pain reduction. The most painful phase was expected to be phase four, ie, during full manipulation, in which four (21%) patients had a VAS score of 0, 12 (63%) patients had a VAS score between 1-3, and three (16%) patients had a VAS score of 4. Thus, 16 out of 19 patients (84%) had no or minimal pain during the most painful phase. There were no complications from the periosteal blocks. Conclusions The periosteal nerve block is an effective procedure providing satisfactory analgesia during the reduction of distal radial and ulnar fractures. It has no side effects and is free from complications associated with conventional sedation.
引言 闭合复位是桡骨远端骨折的一种有效治疗方法。我们展示了一组接受骨膜阻滞闭合手法复位的桡骨远端骨折患者的病例系列。我们详细描述了该技术，并研究了其在闭合复位过程中减轻疼痛效果方面的疗效。方法 纳入19例桡骨远端和尺骨骨折患者，并根据弗赖克曼分类法进行分组。使用10毫升2%利多卡因注射液进行骨膜阻滞来实施复位。通过视觉模拟量表（VAS）在五个阶段记录疼痛程度：1）注射前；2）在静息位镇痛15分钟后；3）在最小活动时；4）在完全手法复位期间；5）术后。VAS评分分为无痛（VAS评分为0）、轻度疼痛（VAS评分在1 - 3之间）和疼痛（VAS评分4及以上）。结果 该研究纳入19例患者[中位年龄53岁（范围：18 - 88岁）]；男性11例（58%），女性8例（42%）。损伤机制为跌倒（n = 12，63%）或机动车事故（n = 7，37%）。第一阶段与所有其他阶段之间的疼痛有统计学显著降低。在不同骨折类型之间，疼痛减轻方面无显著差异。最疼痛的阶段预计是第四阶段，即完全手法复位期间，其中4例（21%）患者VAS评分为0，12例（63%）患者VAS评分在1 - 3之间，3例（16%）患者VAS评分4。因此，19例患者中有16例（84%）在最疼痛阶段无疼痛或疼痛轻微。骨膜阻滞未出现并发症。结论 骨膜神经阻滞是一种有效的方法，在桡骨远端和尺骨骨折复位过程中提供令人满意的镇痛效果。它没有副作用，且不存在与传统镇静相关的并发症。
