Intra-Articular Haematoma Block vs Procedural Sedation for Manipulation of Closed Ankle Fracture Dislocations: An Efficacious, Resource Sparing Solution?

John McFall, Mr Togay Koc and Mr Zeid Morcos

Queen Alexandra Hospital

Procedural sedation (PS) requires two suitably qualified clinicians and a dedicated monitored bed space, increasing demands on Emergency Departments to allocate resources and facilities to safely provide PS. We present the results of intra-articular haematoma blocks (IAHB), using local anaesthetic, for the manipulation of closed ankle fracture dislocations and compared resource use with PS.

Patients received intra-articular ankle haematoma blocks for displaced ankle fractures requiring manipulation between October 2020 to April 2021. Data recorded included the patients’ pain scores, time from first x-ray to reduction and acceptability of reduction. A comparison of temporal variables and resource use was made by retrospective analysis of patients who had undergone PS for manipulation of an ankle fracture over the six-month period March – August 2020.

During the periods assessed, 25 patients received an IAHB and 28 received PS for ankle fractures requiring manipulation (mean age 57.8yr vs 55.1yr). Time from first x-ray to manipulation was 65.9 min (IAHB) vs 82.9 min (PS) (p = 0.087).
In the IAHB group mean pain scores pre, during and post manipulation were 6.1, 4.7 and 2.0 respectively (‘pre’ to ‘during’ p <0.05; ‘pre’ to ‘post’ p <0.01).
In the IAHB group, 24 (92%) had a satisfactory reduction versus 23 (82%) in the PS group. There was no significant difference in the number of unsatisfactory 1st attempt reductions between the groups.

Intra-articular haematoma block of the ankle is an efficacious, safe and inexpensive means of providing analgesia for manipulation of displaced ankle fractures.