Comparison of Hematoma Block andWrist Block in the Treatment of Fracture of Neck of Fifth Metacarpus

Background: Fracture of neck of fifth metacarpal bone or boxer fracture is one of the most common types of hand fracture. Nowadays, two analgesic methods, hematoma block and wrist block, are used at the emergency unit for relocating the fracture. The aim of this study was to compare the advantages and disadvantages of these two methods. Methods: In this randomized clinical trial, all male patients between age of 18 and 60 years were evaluated regarding the inclusion criteria and divided into two groups. In the first group (wrist block), after finding the landmarks and using nerve locator, the radial, median, and ulnar nerves were blocked using 2% lidocaine. In the second group (hematoma block), 2% lidocaine was injected at the site of fracture hematoma. Patients’ pain in both groups was assessed using the visual analogue scale (VAS) before, during, and five minutes after reduction. Correction of angle of fracture and hand grip power were evaluated at two months, post-treatment. Results: Forty-eight patients in the wrist block and 50 patients in the hematoma block were enrolled. In both groups, pain level based on VAS score was decreased during and at five minutes after reduction, which was significant in the wrist block group at both times. No significant associations were detected between correction of angle of fracture and recovery of hand grip power at two months post-treatment with type of analgesia. Also, grip power showed a significant negative association with age, only in the wrist block group. Conclusions: This study demonstrated that wrist block is more effective than hematoma block during and at five minutes after reduction. However, two months after treatment, it was found that grip power was inversely proportional to the age in the wrist block group.