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Randomized Controlled Trial
. 2025 Jul;69(6):e70063.
doi: 10.1111/aas.70063.

Ultrasound-Guided Nerve Blocks Improve Success Rate of Closed Reduction of Colles' Fractures: A Randomised Controlled Trial

Anette B Christensen  1 , Christine IIkjær  2   3 , Torben K Laustrup  2 , Esben Sejer  4 , Camilla Rønnøw  5 , Kaj V Døssing  6 , Troels B Jensen  1 , Jacob K Andersen  7 , Christoffer G Sølling  2
Affiliations
Randomized Controlled Trial

Ultrasound-Guided Nerve Blocks Improve Success Rate of Closed Reduction of Colles' Fractures: A Randomised Controlled Trial

Anette B Christensen et al. Acta Anaesthesiol Scand. 2025 Jul.

Abstract

Background: The initial treatment for distal forearm fractures, including Colles' fractures, involves closed reduction, for which effective pain management is essential. In Colles' fractures, achieving a satisfactory closed reduction may eliminate the need for surgical intervention. While ultrasound-guided nerve blocks are effective, hematoma blocks (HB) are often favored due to their feasibility in the emergency care setting. Further research comparing treatment outcomes is warranted.

Methods: In a multicentre randomised controlled trial, adults with distal forearm fractures were assigned to either ultrasound-guided blocks of the radial and median nerves (US) or HB for closed fracture reduction. The primary endpoint was satisfactory fracture reduction. Secondary endpoints were secondary fracture dislocation, self-reported pain, and time spent in the emergency department.

Results: Among 238 patients with Colles' fracture, 117 received US and 121 received HB. Satisfactory fracture reduction was achieved in 73 (62%) and 49 (40%) patients, respectively (p = 0.01). Surgical correction was conducted in 61 (52%) patients in the US group, contrasting 80 (66%) patients in the HB group (p = 0.03). During the fracture reduction, no difference in self-reported pain was observed (p = 0.21) for patients with distal forearm fractures (n = 247). The median time from block application to fracture reduction was 45 min in the US group and 25 min in the HB group (p < 0.01).

Conclusion: Ultrasound-guided median and radial nerve blocks had a higher success rate for Colles' fracture reduction than the hematoma block group. The influence of anesthetic techniques on the eventual need for surgery requires further investigation.

Keywords: colles' fracture; distal forearm fracture; hematoma block; median nerve block; radial nerve block; ultrasound guided nerve block.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Consort diagram illustrating inclusion, randomisation, and endpoint analysis groups.
FIGURE 2
FIGURE 2
Flowchart presenting the incidence of surgical treatment for patients with a true Colles' fracture in relation to the initial reduction satisfaction.
FIGURE 3
FIGURE 3
The secondary outcome measure of self‐reported pain using an 11‐point numeric rating scale (0–10) for both groups.
See this image and copyright information in PMC

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