Emerg Med J 30:211-213 doi:10.1136/emermed-2011-200782
  • Original article

Management of distal radius fractures in emergency departments in England and Wales

  1. Simon White4
  1. 1Department of Trauma and Orthopaedics, Royal Gwent Hospital, Newport, UK
  2. 2Department of Trauma and Orthopaedics, Avon Orthopaedic Centre, Bristol, UK
  3. 3Department of Trauma and Orthopaedics, Leicester Royal Infirmary, Leicester, UK
  4. 4Department of Trauma and Orthopaedics, University Hospital of Wales, Cardiff, UK
  1. Correspondence to Harry Sprot, Royal Gwent Hospital, Cardiff Road, Newport, Gwent NP10 8UD, South Wales, UK; harrysprot{at}
  1. Contributors HS was responsible for data collection, analysis of results and primary authorship of the paper. AM and AO contributed to the design, data collection and editing of the paper. JP contributed to the design and editing of the paper. SW contributed to the design and data analysis and was overall project lead and senior author. All authors were involved in the preparation of the manuscript and approved it in its final form.

  • Accepted 19 February 2012
  • Published Online First 20 March 2012


Aims To examine variations and consistencies in the emergency management of distal radial fractures across England and Wales.

Methods A survey was conducted of emergency departments (ED) in England and Wales regarding the acute management of patients with distal radius fractures. The study investigated the use of anaesthesia, the person performing both the anaesthetic and the manipulation, the use of resuscitation facilities and monitoring, the cast applied, the follow-up and the management of complex injuries or those in younger patients.

Results Surveys were conducted in 105 units, giving a response rate of 91% of ED in England and Wales. The most frequent anaesthetic types were haematoma block (50%), intravenous benzodiazepines (20%), Bier's block (17%) and a small minority using other techniques such as brachial plexus blocks (2%). Basic cardiorespiratory monitoring was variable, and 10% of trusts did not routinely monitor patients undergoing Bier's blocks or manipulation with sedatives. Only 50% of ED would manipulate comminuted fractures or fractures in young adult patients.

Conclusion There are significant regional variations. The use of monitoring is highly variable and there are no consistent standards when administering potentially potent anaesthetic medications. The low percentage of units attempting reduction of complex fractures or fractures in young patients will disadvantage training in ED as well as patients. Guidelines are required to improve care, which is highly inconsistent at present.


  • An additional appendix is published online only. To view this files please visit the journal online (

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

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