Introduction: Distal radius fractures account for up to 18% of fractures in older adults and up to 20% of all fractures treated in the emergency department (ED). These fractures often require reduction and immobilization, with different modalities to provide analgesia. Our objective in this study was to summarize the management for distal radius fracture reductions in the real world of community and academic EDs.
\nMethods: Following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and retrospective chart review guidelines for cohort studies, we identified adult visits for isolated distal radius fractures over a four-year period across three academic and 18 community hospital EDs from more than 490,000 per annum total visits. Visits were grouped by whether they were reduced in the ED. Reductions were further categorized by use of ultrasound-guided nerve block (UGNB), procedural sedation, or hematoma block. We recorded patient demographics, including age, sex, race and ethnicity, and Emergency Severity Index scores. Our primary outcome was patient-reported pain scores (0-10 scale) at presentation and prior to disposition. Secondary outcomes were total milligrams of morphine equivalents administered, ED length of stay and 30-day ED return rates. We used Kruskal-Wallis (numeric) and chi-squared or Fisher exact (categorical) tests to compare characteristics.
\nResults: There were 3,642 total patients with distal radius fractures, and 2,608 (71.6%) met inclusion criteria. Of the patients included, 695 (26.6%) received fracture reduction. Of the reductions performed, 522 (75.1%) received hematoma blocks, 151 (21.7%) received procedural sedation, and 22 (3.2%) received UGNB. The majority of UGNB (72.7%, n = 16), procedural sedation (64.2%, n = 97), and hematoma block reductions (51.3%, n = 268) were performed in community hospital EDs. Patient age was greatest for the hematoma block (median 67 [57, 76]), followed by no ED reduction (65 [51, 77]), UGNB (65 [51, 68]), and procedural sedation (62 [43, 72]) (P < .01 for the four-group comparison). The majority of patients (93.7%) were White and not Hispanic or Latino (94.5%). There was no difference in treatment type by race or ethnicity. Pain score reduction between arrival and the last score reported in the ED was statistically greatest for the procedural sedation group (8 to 4, difference of -4 [-6, -2]), followed by UGNB (8 to 5, difference of -3 [-5, 0]), hematoma block (8 to 5, difference of -3 [-5, 0]) and no reduction (7 to 5, difference of -2 [-4, 0]), (P < .001 for the four-group comparison). Median total milligrams of morphine equivalents was higher for UGNB (7.5 [6.8, 13.9]) and procedural sedation (7.5 [2.0, 14.0]), as compared to hematoma block (6.7 [0, 13.0]) and no ED reduction (4.0 [0.0, 7.5]) (P < .001 for the four-group comparison). Length of stay in the ED was longest for the UGNB group (314 minutes [226, 432]) when compared to hematoma block (275 minutes [204, 370]), procedural sedation (258 minutes [192, 350]) (P = .08), and no reduction (190 [127, 290]) (P < .001 for the four-group comparison). Thirty-day return rates were 16.6% for procedural sedation, 15.1% for hematoma block, 12.3% for no reduction, and 9.1% for UGNB (P = .18).
\nConclusion: Most distal radius fracture reductions were performed with a hematoma block. Ultrasound-guided nerve block was a less commonly used alternative to procedural sedation and was performed predominantly in the community hospital ED setting. Procedural sedation and UGNB were most effective at reducing pain. Triage severity scores, milligrams of morphine equivalents administered, and length of stay were similar between UGNB and procedural sedation.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"ultrasonography interventional"},{"word":"nerve block"},{"word":"Brachial Plexus Block"},{"word":"Wrist Fractures"},{"word":"conscious sedation"},{"word":"hematoma"},{"word":"Anesthesia Local"},{"word":"Closed Fracture Reduction"},{"word":"Emergency Service Hospital"},{"word":"pain management"}],"section":"Clinical Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6n44g0hz","frozenauthors":[{"first_name":"Steven","middle_name":"C.","last_name":"Mahnke","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota","department":""},{"first_name":"Vanessa","middle_name":"H.","last_name":"Newburn","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota","department":""},{"first_name":"Carolina","middle_name":"D.","last_name":"Hooper","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota","department":""},{"first_name":"Aidan","middle_name":"F.","last_name":"Mullan","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota","department":""},{"first_name":"Fernanda","middle_name":"","last_name":"Bellolio","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota","department":""},{"first_name":"Daniel","middle_name":"","last_name":"Fiterman Molinari","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota","department":""}],"date_submitted":"2025-06-26T17:30:58.604000Z","date_accepted":"2025-11-03T06:02:49.901000Z","date_published":"2026-02-11T03:48:00Z","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/48817/galley/49057/download/"}]}