Hematoma Block

Abstract

Hematoma blocks are useful to help control pain during fracture reduction. The principle is to inject the fracture hematoma itself with a local anesthetic, therefore directly anesthetizing the bony ends. Many fracture reductions are appropriate for a hematoma block, with the exceptions of open fractures, fractures greater than 2 days old, and fractures in the setting of possible infection. Superficial sites such as the distal radius, metacarpals, and ankle are the most commonly used because local landmarks are palpable and neurovascular anatomy is well defined. In general, local anesthetics without epinephrine should be used given the low volume needed and the risk of causing vascular injury in the digits and extremities.