Przejdź do treściAn ultrasound-guided radial nerve block may be a useful alternative to a hematoma block during closed reduction of a distal radius fracture. In a small randomised trial, more patients achieved a clinically meaningful reduction in pain from admission to the reduction manoeuvre, but the result is not strong enough to establish a new standard of care.
Why might an orthopaedic surgeon find this study interesting?
Closed reduction of a displaced distal radius fracture can be very painful. Emergency departments use several analgesic strategies, including hematoma block, sedation, regional anaesthesia or combinations of these approaches. A hematoma block is simple and does not require advanced equipment, but injecting local anaesthetic around the fracture does not always provide sufficient comfort. An ultrasound-guided nerve block, by contrast, allows local anaesthetic to be placed away from the fracture itself while the needle and surrounding anatomy are directly visualised.
The study, conducted at Hospital Universitario San Ignacio and Pontificia Universidad Javeriana in Bogotá and published online on 7 August 2026 in Journal of Hand Surgery Global Online, compared an ultrasound-guided supracondylar radial nerve block with a conventional hematoma block in patients requiring fracture reduction in the emergency department.
Question and methodology
Adults with an acute distal radius fracture diagnosed within the first week after injury were enrolled in the randomised trial. Patients and clinicians performing the procedure could not be blinded, whereas outcome analysis was blinded.
Fifty patients were included in the final analysis: 28 received the ultrasound-guided radial nerve block and 22 received a hematoma block. Median age was 62 years, and most participants were women. Pain was measured on a numerical rating scale at admission, 10 minutes after anaesthesia and during the reduction manoeuvre. The investigators also assessed radiographic reduction quality and recorded complications during the emergency-department stay and at a telephone follow-up after 2 weeks.
Results
There was no clinically meaningful between-group difference in the proportion of patients achieving at least a 2-point pain improvement either from admission to 10 minutes after the block or from the block to the reduction manoeuvre.
A difference emerged when pain at admission was compared with pain during reduction. A clinically meaningful improvement was more frequent after the ultrasound-guided radial nerve block: the relative probability of improvement was 2.10 (95% CI 1.06–5.04), with an absolute risk difference of 29.9 percentage points. The authors calculated an NNT of 4. This result should be interpreted cautiously because the confidence interval was wide and the p value was 0.047, close to the conventional threshold for statistical significance.
Radiographic measures of reduction quality did not differ significantly between groups. In other words, the signal for better pain control did not translate into measurably better fracture alignment in this trial.
How should the findings be interpreted clinically?
The most defensible conclusion is not that an ultrasound-guided nerve block is superior to a hematoma block. The evidence is too limited for that. Rather, the study suggests that a targeted regional block can be performed in the acute emergency setting and may increase the likelihood of a meaningful reduction in pain during fracture reduction.
This may be particularly relevant in departments with experience in ultrasound-guided regional anaesthesia and an interest in reducing the need for deeper sedation. Ultrasound availability alone, however, does not replace knowledge of anatomy, regional anaesthesia principles or appropriate patient monitoring. Choice of analgesia should still reflect fracture characteristics, the patient’s clinical condition, staff expertise and the local protocol.
Limitations
- The study was small, with only 50 patients in the final analysis.
- Patients and clinicians performing the block could not be fully blinded.
- The key positive result had a wide confidence interval and a p value close to 0.05.
- Safety follow-up lasted only 2 weeks.
- This was a single-centre study, so results may depend on operator experience with ultrasound and regional blocks.
- Radiographic quality of reduction was not improved.
What might this change in practice — and what does the study not prove?
The trial provides a reasonable signal that an ultrasound-guided supracondylar radial nerve block can be considered among the analgesic options for closed reduction of distal radius fractures. Before it replaces hematoma block in routine care, larger multicentre studies are needed, ideally with a clearly specified primary endpoint and assessment of rescue analgesia, procedure time, complications and patient satisfaction.
The study does not prove that the ultrasound-guided block produces a better reduction, is safer than a hematoma block or eliminates the need for sedation in every patient. It also did not show superiority at every pain-assessment time point. At present, the findings support further evaluation and selective use rather than a wholesale change in standard practice.
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Source
Olmos Muskus N, Botero Bermúdez M, Caro Hurtado D, Mejía Grueso A, Cadena De-Poortere V, García González LA. Ultrasound-Guided Supracondylar Radial Nerve Block Versus Hematoma Block for Closed Reductions of Distal Radius Fracture in the Emergency Department: A Randomized Controlled Clinical Trial. Journal of Hand Surgery Global Online. 2026;8(6):101095. DOI: 10.1016/j.jhsg.2026.101095. PubMed PMID: 42604104.
Educational material for healthcare professionals. It does not constitute an individual therapeutic recommendation.
Content prepared by: Tomasz Poboży - orthopaedic surgeon.