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Original research
Haematoma block is the most efficient technique for closed forearm fracture reduction: a retrospective cohort study
  1. Georgia Rose Pitman1,
  2. Torgrim Soeyland2,
  3. Gordana Popovic3,
  4. David Thomson2
  1. 1 Hunter New England Local Health District, New Lambton, New South Wales, Australia
  2. 2 Emergency Medicine, Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
  3. 3 Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Torgrim Soeyland; Torgrim.Soeyland{at}health.nsw.gov.au

Abstract

Background Forearm fractures are a common ED presentation. This study aimed to compare the resource utilisation of three anaesthetic techniques used for closed forearm fracture reduction in the ED: haematoma block (HB), Bier’s block (BB) and procedural sedation (PS).

Methods A retrospective multicentre cohort study was conducted of adult patients presenting to either Port Macquarie Base Hospital ED or Kempsey District Hospital ED in New South Wales, Australia, from January 2018 to June 2021. Patients requiring a closed reduction in the ED were included. ED length of stay (LOS) was compared using a likelihood ratio test. Successful reduction on the first attempt and the number of ED specialists present for each method were both modelled with a linear regression. Staff utilisation by the level of training, cost of consumables and complications for each group were presented as descriptive statistics.

Results A total of 226 forearm fractures were included. 84 used HB, 35 BB and 107 PS. The mean ED LOS was lowest for HB (187.7 min) compared with BB (227.2 min) and PS (239.3 min) (p=0.023). The number of ED specialists required for PS was higher when compared with HB and BB (p=0.001). The cost of consumables and a total number of staff were considerably lower for HB compared with PS and BB methods. PS had the highest proportion of successful reductions on the first attempt (94.4%) compared with BB (88.6%) and HB (76.2%) (p=0.006). More patients experienced complications from PS (17.8%) compared with BB (14.3%) and HB (13.1%).

Conclusions In this study, the HB method was the most efficient as it was associated with a shorter ED LOS, lower cost and staff resource utilisation. Although PS had a significantly greater proportion of successful reductions on the first attempt, HB had fewer complications than BB and PS. EDs with limited resources should consider using HB or BB as the initial technique for fracture reduction with PS used for failed HB or when regional blocks are contraindicated.

  • fractures and dislocations
  • cost efficiency
  • emergency department
  • analgesia
  • trauma

Data availability statement

Data are available upon reasonable request. Data can be available upon contacting the corresponding author and specific authorisation from the Local Health Network the study was done with.

https://doi.org/10.1136/emermed-2023-213591

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    Data availability statement

    Data are available upon reasonable request. Data can be available upon contacting the corresponding author and specific authorisation from the Local Health Network the study was done with.

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    Footnotes

    • Handling editor David Metcalfe

    • Contributors GRP researched background literature, designed data extraction tool, extricated data and authored the manuscript. TS initiated the study question and reviewed and supervised the study, adjudicated on data discrepancies and co-authored the manuscript. GP provided statistical advice and review. DT co-supervised the study, reviewed the study questions, data and manuscript. TS is the overall guarantor.

    • Funding The authors would like to thank the medical records staff at the Port Macquarie Base Hospital that helped with data extraction and the support for the original honours project at the University of New South Wales, Port Macquarie Rural Clinical School.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.