Background
Limb injuries were the second leading cause (22.1%) for attending an NSW ED. Distal radial fractures are often sustained following a fall and have an associated health system cost of 1.3M per annum. Over 90% of patients with distal radial fractures were discharged from ED. Over 70% of distal radial fractures required closed reduction, which can be undertaken using haematoma block or intravenous sedation.

Aims
To explore the effectiveness of using haematoma blocks (HTB) verses intravenous sedation in managing closed reduction of distal radial fractures by emergency nurse practitioners.

Methods
This study used a match-case study design. Patients (n=50) with confirmed fractures requiring closed reduction from 2022 and 2023 were retrospectively reviewed. Presentations were matched 1:1 by age, sex, triage category, fracture type, mechanism of injury and discharge status. Analysis included pre and post pain scores, procedural time, ED length of stay and adverse events.

Results
Patients were largely female aged over 60 years with moderate to severe pain. Majority of patients received pre-hospital non-opiate analgesia (60.5%) . No significant differences were found between sample and match-case controls. Closed reduction using HTB had a shorter procedure time (1.6h vs. 2.7; p<.001), ED length of stay (4.2 vs. 5.6; p<.001) and less pain post reduction (0/10 vs. 3/10; p<.001). While adverse events were expected and managed in control cases using conscious sedation, no adverse events were observed in the HTB group

Conclusion
Displaced distal radial fractures are common injuries managed in ED by physicians and nurse practitioners. Our findings indicate that the use of HTB is safe, results in shorter ED lengths of stay, greater pain management with low impact on ED resources.