Wrist Fractures

• For fractures of the distal radius in patients aged ≥50 years with moderately displaced fractures there is evidence for those over the age of 65 years that manipulation may not improve functional outcome, stiffness, final radiological position or cosmesis compared to no manipulation.
• panel of experts agreed that ulnar variance and dorsal tilt are the most important extra-articular parameters and step is the most important intra-articular parameter. Consensus was gained on thresholds for intervention for all parameters for the three age groups except ulnar variance in a 75 year old patient

• The needle is then inserted into the fracture site usually blindly through readjustments until the needle “falls” into the fracture with loss of resistance or USS can be useful
• 8-10ml 1% or 2% Lignocaine is then instilled after checking for 'flash back'

References include:
Brit Soc for Hand Surg - review of anaesthesia techniques