Hematoma Block of the Wrist
This video demonstrates proper technique for performing a hematoma block prior to reducing a distal radius fracture. For convenience, below is a brief outline of the steps:
SUPPLIES
You will need: gloves and a cleansing solution such as alcohol wipes, iodine, or chlorhexidine solution. 1 or 2 % lidocaine without epinephrine, an 18 gauge needle to draw lidocaine, another 18 gauge and a 27 gauge needle for infiltration as well as a 15 mL syringe.
Steps:
After obtaining x-rays to confirm a fracture and providing the patient analgesia in the form of ice packs and oral pain relievers, identify the fracture sign over the dorsal aspect of the forearm
Identify and mark your injection site by palpating for the step off of the fracture.
Use a 27 gauge needle to create a t 1cc wheal of lidocaine at the skin surface to anes-the-tize the skin.
Disinfect the skin with an antiseptic solution such as betadine or chloraprep.
Insert an 18 gauge needle through the skin wheal into the hematoma until bone is encountered - confirm correct placement by aspirating blood.
Inject 5 to 15 mLs of 1% lidocaine into the fracture cavity and around the surrounding periosteum. You may also inject 5 to 10 mLs of 2% lidocaine.
*The most common mistake in hematoma blocks is attempting the reduction without allowing sufficient time for the block to take effect. Wait at least 5 to 10 minutes before proceeding.
AUTHORS: Fahad Ali, MD & Nicholas J Musisca, MD FACEP