Tips, Quips, and PearlsThe Hematoma Block: A Simple, Effective Technique for Closed Reduction of Ankle Fracture Dislocations
Section snippets
Anatomy
When administering the hematoma block, it is imperative to be familiar with the local neurovascular structures, soft tissue (tendons, ligaments, and capsule), and the osseous structures. The talocrural joint is composed of the tibia, talus, and fibula, which articulate primarily in the sagittal plane. The hematoma block can be readily administered through the anterior portals of the ankle with the patient in the supine position (9, 10). The anesthetic is deposited in the space between the
Technique
Before performing the procedure, the patient must first be identified as an acceptable candidate for the hematoma block. Patients with a history of liver cirrhosis or any form of hepatic insufficiency, hypersensitivity to local anesthetics, or younger than 3 years of age are considered unsuitable candidates for this technique (2). When performing a hematoma block for the treatment of an ankle fracture dislocation, the patient is positioned supine, the tibialis anterior tendon and medial
Discussion
Ankle fracture dislocations are a common injury treated in the emergency department setting. Conscious sedation can be a contraindication owing to the associated systemic effects or be unavailable in some community institutions. The hematoma block has been used as a method to achieve regional anesthesia for attempted closed reduction of ankle fracture dislocations. Hematoma blocks minimize the inherent complications of conscious sedation in select patients.
In 2008, White et al (1) prospectively
References (12)
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Arthroscopically detected intra-articular lesions associated with acute ankle fractures
J Bone Joint Surg
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The efficacy and safety of the hematoma block for fracture reduction in closed, isolated fractures
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Anesthesia and analgesia for the ambulatory management of fractures in children
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Ultrasound guided hematoma block: A novel use of ultrasound in the traumatized patient
J Trauma
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