Prepared Physician’s Monthly Pearl of Wisdom for April 2021, Flipping Over Hematoma Blocks

Not long ago, one of my colleagues’ ambitious nephews was striving to complete as many mid air flips as possible on the trampoline. After completing seven full flips in the air, he had an awkward landing that resulted in a fracture dislocation of his ankle. 

He arrived in the Emergency Department with his foot twisted laterally and beginning to have a dusky appearance, with his distal capillary refill pushing 10 seconds.

We quickly performed a hematoma block and reduced the ankle and foot back to anatomical position, with nearly no pain. His foot quickly became a healthy color, and his capillary refill was now less than 3 seconds.

Hematoma Block is a reasonable, safe means of anesthesia for simple, closed distal extremity fractures requiring quick reduction maneuvers. Prep the skin over the fracture site with antiseptic solution, confirm needle placement in the fracture hematoma by aspiration of blood. Slowly inject 5-15 mL of plain lidocaine into the fracture cavity and around the associated periosteum. Allow 5-15 minutes for anesthetic effect to be achieved.

Roberts, JA et al. Clinical Procedures in Emergency Medicine and Acute Care, 2019; 536-537.

With Prepared Physician’s Suture Kits, outfitted with Lidocaine and Sam Splint, you can comfortably avoid the complications of neurovascular compromise with quick action, until you can get your injured loved one to definitive Orthopedic care.

Nathan Whittaker, MD

Prepared Physician