Fri., 10/19/07 Foot & Ankle, Paper #32, 3:15 pm OTA-2007
Closed Reduction of Ankle Fracture-Dislocations Comparing Conscious Intravenous Sedation to Intra-Articular Injection: A Prospective Randomized Trial
Brian J. White, MD (n); Kenneth A. Egol, MD (n); Michael Walsh, PhD (n);
Nirmal C. Tejwani, MD (n);
NYU Hospital for Joint Diseases, New York, New York, USA
Purpose: Ankle fracture-dislocations require emergent reduction to prevent further soft-tissue compromise and minimize articular injury. Currently, conscious intravenous (IV) sedation is used to provide analgesia for the closed reduction of this injury. Our hypothesis was that an intra-articular hematoma block of the ankle would provide similar analgesia and ability to reduce the dislocation when compared to conscious IV sedation.
Methods: Following IRB approval and power analysis, 42 patients with ankle fracture-dislocations were enrolled between September 2005 and January 2007. We defined an ankle fracture-dislocation as a fracture of the ankle associated with complete dislocation of the talus from beneath the tibia. The patients were prospectively randomized to either conscious sedation or an intra-articular hematoma block for the reduction of their injury and the application of a plaster splint. Each group included 21 patients. The medications for conscious sedation were either Propofol or Versed. The ankle hematoma block consisted of 12 cc of 1% Lidocaine without epinephrine injected into the ankle joint using sterile technique. Patients used the visual analog pain scale to rate their pain from 1 to 10 before, during, and after the reduction maneuver. The postreduction radiographs were reviewed for congruity of the ankle mortise by the senior authors.
Results: The data were analyzed using paired t tests. The average pain reduction after medication was 4.6 (standard deviation [SD] = 3.3) for the block group and 4.15 (SD = 3.5) for the sedation group (P = 0.64). The average improvement in pain after ankle reduction was 3.6 (SD = 3.8) for the block group and 4.1 (SD = 3.3) for the sedation group (P = 0.71). Neither of these differences was significant. Both conscious sedation and ankle block allowed successful reduction of the ankle dislocation and the pain was controlled to similar levels. All fracture dislocations were reduced successfully and no complications were noted in either group.
Conclusions: An intra-articular hematoma block provides analgesia for closed reduction of ankle fracture dislocations similar to that obtained with conscious sedation with no complications. The use of intra-articular injection avoids the potential morbidity associated with conscious sedation and may allow for more expedient management of the ankle dislocation.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.