<i>SHOULD THE INTRA-ARTICULAR </i><i>HAEMATOMA BLOCK BE USED AS </i><i>AN ALTERNATIVE TO PROCEDURAL </i><i>SEDATION FOR THE CLOSED </i><i>REDUCTION OF UNSTABLE ANKLE </i><i>FRACTURES AND DISLOCATIONS IN</i><i>THE EMERGENCY DEPARTMENT?</i>
<p dir="ltr">Aims and objectives: To clarify if the intra-articular haematoma block is a viable and safe</p><p dir="ltr">option for the manipulation of unstable ankle fractures and dislocations in the Emergency</p><p dir="ltr">Department, with expected benefits of time, cost and resource efficiency, when compared</p><p dir="ltr">to procedural sedation.</p><p dir="ltr">Background: The current first-line approach for the manipulation of unstable ankle injuries</p><p dir="ltr">in New Zealand Emergency Departments is procedural sedation. The intra-articular</p><p dir="ltr">haematoma block of the ankle is not standard practice and remains relatively unknown.</p><p dir="ltr">Design: Integrative literature review.</p><p dir="ltr">Method: Seven databases were searched. The search was limited to the English language</p><p dir="ltr">and reference lists were reviewed. The Cochrane Risk of Bias tool was used for quality</p><p dir="ltr">assessment of the included studies.</p><p dir="ltr">Results: Just three studies were identified that met inclusion criteria, only one was a</p><p dir="ltr">randomised control trial. Two of the studies were at high risk of bias. The studies found no</p><p dir="ltr">significant difference in the rate of successful reduction when the intra-articular</p><p dir="ltr">haematoma block was used compared to procedural sedation. Two studies conducted a</p><p dir="ltr">patient questionnaire and found no significant difference in pain scores between the</p><p dir="ltr">groups. One study found that the intra-articular haematoma block facilitated a timelier</p><p dir="ltr">reduction in the case of subluxation, but more attempts to reduce were required when it</p><p dir="ltr">was used for dislocation. No adverse events were reported in the intra-articular haematoma</p><p dir="ltr">block groups, however, the studies were not longitudinal in nature, so did not measure</p><p dir="ltr">outcomes of joint sepsis or chondrolysis. The included studies referred to the evidence for</p><p dir="ltr">the haematoma block for wrist fractures and intra-articular anaesthesia for glenohumeral</p><p dir="ltr">dislocations as comparable procedures.</p><p dir="ltr">Conclusion: Current evidence suggests the intra-articular haematoma block is safe and</p><p dir="ltr">effective but is limited by the studies number and quality, therefore further research is</p><p dir="ltr">required. A quantified risk of chondrolysis following single dose intra-articular local</p><p dir="ltr">anaesthesia should be established before the intra-articular haematoma block is made</p><p dir="ltr">standard practice, but it can be considered in situations where the risk of procedural</p><p dir="ltr">sedation outweighs the likely very low risk of chondrolysis.</p>
