![]() A recent prospective survey, conducted in six centres in the UK, of Colles' fracture in patients aged 35 years and above, reported the overall annual incidence of this fracture to be 9/10,000 in men and 37/10,000 in women ( O'Neill 2001). It has been estimated that a 50 year old white woman in the USA or Northern Europe has a 15 per cent lifetime risk of a distal radius fracture whereas a white man of the same age has a lifetime risk of a little over two per cent ( Cummings 1985). All trials evaluating adjuncts failed to provide evidence on eventual clinical outcome.Ī seriously flawed study comparing bupivacaine with prilocaine for IVRA gave some insight on the potential confounding effects of treatment by different doctors on patient outcome.įractures of the distal radius are one of the most common fractures in many predominantly white and older populations ( Sahlin 1990 Singer 1998). The addition of two different muscle relaxants and one analgesic was tested for IVRA one sedative and hyaluronidase for haematoma block and clonidine for brachial plexus block. Six trials examined the use of drug adjuncts. ![]() None of the three trials evaluating three different physical aspects of anaesthesia (injection site of, or extra tourniquet, for IVRA and technique for brachial plexus block) provided conclusive evidence for the effectiveness and safety of the novel technique. There was inadequate evidence of the relative effectiveness of different methods of anaesthesia from the following comparisons, all examined within single trials only: nerve block versus haematoma block intravenous sedation versus haematoma block general anaesthesia versus haematoma block general anaesthesia versus sedation and general anaesthesia versus haematoma block and sedation. In contrast, haematoma block was quicker and easier to perform and less resource intensive. All studies had serious methodological limitations, notably in the frequent failure to assess clinically important and longer‐term outcomes.įive trials provided evidence that, when compared with haematoma block, IVRA provided better analgesia during fracture manipulation and enabled better and easier reduction of the fracture, with some indication of a reduced risk of later redislocation or need for re‐reduction. The 18 included studies involved at least 1200, mainly female and older, patients with fractures of the distal radius.
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