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The Hematoma Block: A Simple, Effective Technique for Closed Reduction of Ankle Fracture Dislocations

https://doi.org/10.1053/j.jfas.2011.04.037Get rights and content

Abstract

Management of a dislocated ankle fracture can be challenging because of instability of the ankle mortise, a compromised soft tissue envelope, and the potential neurovascular compromise. Every effort should be made to quickly and efficiently relocate the disrupted ankle joint. Within the emergency department setting, narcotics and benzodiazepines can be used to sedate the patient before attempting closed reduction. The combination of narcotics and benzodiazepines provides relief of pain and muscle guarding; however, it conveys a risk of seizure as well as respiratory arrest. An alternative to conscious sedation is the hematoma block, or an intra-articular local anesthetic injection in the ankle joint and the associated fracture hematoma. The hematoma block offers a comparable amount of analgesia to conscious sedation without the additional cardiovascular risk, hospital cost, and procedure time.

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

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There are more references available in the full text version of this article.

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Conflict of Interest: None reported.

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