Distal radius fracture hematoma block

Indications/Contraindications

Local analgesia in preparation for a distal radius fracture reduction or other maneuver.

Materials/positioning

• 10cc 1% or 2% Lidocaine with or without epinephrine
• 10cc Syringe Body
• 18ga Needle
• CHG Prep Stick
• Something to catch leaking blood (gauze or bandaid)

Technique

1. Locate general area for injection: Always inject via dorsal side / Never inject via volar side, regardless of injury pattern
2. Inspection/palpation: Palpate fracture step off and make mark at site with needle cap (do not mark with ink or marker, this will come off
3. Clean skin, allow to dry
4. At roughly a 45 degree angle with your needle tip facing distal, enter directly into fracture site.
5. Confirm placement: aspirate to confirm presence of fracture hematoma
6. Inject lidocaine into hematoma, with repeated aspiration/injection to break up hematoma if needed
7. Withdraw needle, cap, cover with gauze and dispose of needle safely in sharps container

Pearls & Pitfalls

Potential complications:
Failure to confirm you are in the hematoma can lead to local subcutaneous infiltration instead.