Objective/Hypothesis: Distal radius fractures (DRFs) are still treated conservatively with closed reduction in the emergency department (ED) for certain indications such as infirmity or patient preference. The quality of reduction depends on multiple variables such as inherent stability of the fracture, quality of casting, patient adherence, and the type of anesthesia used in the ED. The purpose of this study was to compare the quality of radiographic fracture reduction performed in the ED using sedation anesthesia with that of using hematoma block anesthesia. Materials and Methods: A retrospective case-control study of 240 DRF reductions was done. Thirty of them were treated with sedation and 210 with a hematoma block. Inclusion criteria included age greater than 18 years and availability of adequate radiographic series including pre- and post-reduction true posteroanterior (PA) and lateral radiographs. Exclusion criteria included immediate hospitalization for operative reduction and fixation, pregnancy, and chronic cognitive impairment. Pre- and post-reduction radiographs were reviewed for volar tilt, radial angulation, radial height, and ulnar variance. Patient charts were reviewed for demographic data, background disease, and experience of the reducing surgeon. Results: Both groups were similar in gender, background illnesses, concomitant injuries, surgeon experience, and fracture radiographic classification. Surgeon experience did not affect the quality of reduction. No complications related to the anesthesia were noted. The sedation group spent more time in the ED (P = .001). Post-reduction values of volar tilt were better in the sedation group (P = .03). Volar tilt and ulnar variance improved more in the sedation group (P = .001). Conclusions:(1) Both types of anesthesia carried minimal complications and achieved reduction. (2) Sedation seemed to be more efficient than hematoma block in supporting closed reduction of DRF in the ED. However, it required certified personnel and the patient spent more time in the ED. (3) Because both types of anesthesia are acceptable, we suggest using sedation when the ED reduction is the final reduction, ie, when the patient is planned to continue with conservative treatment.
