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An important part of the treatment of your broken wrist today is to reduce the fracture (put the broken bones back in place) in order for the break to heal as well as possible. Most commonly we perform this procedure under local anaesthetic using a tight blood pressure cuff and an injection of local anaesthetic medication into the arm on the broken side. It is called an ‘Ischaemic Arm Block’ or a ‘Bier’s Block’ (named after the man who developed this method). This procedure is used because it is generally very effective and safe. You will be asked to give your consent for this procedure.

HOW  DOES  IT  WORK?A drip (IV luer) will be placed into the broken arm (usually the top of the hand). This is for the anaesthetic medication. Another drip will be placed in the other arm so that we can give additional medications if necessary.

A special blood pressure cuff will be placed around your upper arm and blown up very tight – this is to stop the medication from ‘escaping’ from your forearm. Once the anaesthetic medication is injected, the cuff will have to remain tight for at least 20 minutes minimum.

You might notice tingling and colour change in your forearm ‐ this is entirely normal. We will check your pain before starting.

The Bier’s Block does NOT take away all sensation. You might be aware of pressure and movement. The Clinical Nurse Specialist or the Doctor will then attempt to reset the fracture with a combination of pulling and pushing your hand and wrist.

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YOUR WRIST FRACTURE

Colles’ fracture Smith’s fracture

Barton’s fracture

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WHAT ARE THE POSSIBLE SIDE EFFECTS of the treatment / procedure?• Pain at the injection site and cuff. The cuff has to be tight to be effective• Bruising or bleeding especially at the IV drip site• Infection at the injection site • Allergic reaction (rare) • Failure to block the nerves completely (about 5 ‐10%) • Minor skin injury • Failure to adequately reduce the fracture • ‘Pins‐n‐needles’ around the mouth, dizziness, slow heartbeat• Convulsions (0.2 – 1 %) • Reaction to the anaesthetic medication that affects the oxygen carrying

ability of your blood (very rare)

You will be carefully monitored during the procedure by heart tracing and finger‐tip oxygen meter. The whole procedure usually lasts 30 ‐ 40 minutes.

You should not have the procedure if you have a known allergy to Local Anaesthetic medications (such as ‘Lignocaine’), or if your blood pressure is too high (SBP >180 mmHg). Your nurse or doctor will go through a full safety check list with you. If you are not able to have the Bier’s Block procedure - your doctor or Clinical Nurse Specialist will discuss the other options with you.

An X-ray of your wrist might be taken in the room while the tight cuff is still on your arm. This might allow a 2

nd try if the position is not good enough. The blood pressure cuff will then be released and the blood flow and sensation will return to the forearm.

Your forearm will be put in a ‘Plaster of Paris’ cast, which is usually split with a plaster saw.

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WRIST FRACTURE TREATMENT: BIERS BLOCK

If you have any other questions regarding your treatment options, please ask your doctor.

It is possible that you may still need surgery. This will be decided on by the Orthopaedic team today or at clinic

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HOW TO TAKE CARE OF YOUR PLASTER

Water makes the plaster go soft. Wrap the cast in a towel and a plastic bag before you go in the bath or shower, and seal ends with tape.

Do not bang or rest your plaster on hard surfaces as this can make the plaster go soft. If you want to write on the plaster cast, wait until the cast is dry and hard.

Do not push objects inside your cast as this can damage the cast or your skin. Do not let sand, dirt or powder get inside your cast. Do not pull padding out from inside your cast.

Keep your injured arm or leg above your heart for 1‐3 days after the injury. Use your sling to rest your arm until the plaster is fully dry.

Pain Injured arms or legs keep swelling for 1‐3 days after an injury. This can cause pain or cause the plaster to feel tight. If your arm or leg is a little sore, try some pain relief such as paracetamol.

Move the fingers outside the plaster as much as possible.

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DANGER  SIGNS  -­‐  When  to  come  back  to  the  Emergency  DepartmentDANGER  SIGNS  -­‐  When  to  come  back  to  the  Emergency  DepartmentIf  you  no(ce:                                                                                                                                          Or  if  you:If  you  no(ce:                                                                                                                                          Or  if  you:

• Numbness  or  (ngling  in  your  fingers• Your  fingers  look  blue  or  swollen

• If  you  have  severe  pain• You  can’t  move  your  fingers

DIAL  111  for  an  AMBULANCEDIAL  111  for  an  AMBULANCE

Plaster casts protect injured bones and help them to heal. To work well, a cast should be dry and hard, fit your arm well. Plaster casts dry slowly, and might take 2-3 days to become fully dry and hard.

If the plaster is cracked or soft or loose, you need a new plaster, but this is not an emergency. You should go to your family doctor, or to the nearest Accident & Medical Clinic within 24 hours for a check.

It is very important that you have your cast check within the next 24 hrs. You can have this done at your local A & E or your usual family doctor.

YOUR PLASTER CAST

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Your Doctor or Clinical Nurse Specialist has referred you to the ‘Orthopaedic Fracture Clinic’

The Orthopaedic doctors will have a look at your X-Rays and the referral letter, and work out when you should have your appointment.

Once the date and time of your Fracture Clinic appointment has been decided, the Orthopaedic Booking Clerk will either send

you a letter about this, or phone you if the appointment is quite soon.

If you have not received a letter or a phone call within 10 days from your visit to Emergency Department: please phone the Orthopaedic Bookings at North Shore Hospital to find out about your appointment: Phone: (09) 486 8900 extension 7190

Sometimes the Orthopaedic doctor will look at the X-rays and the referral letter, and decide that your family doctor could look after your injury. If this happens they will also write to you, or phone you or your family doctor so that you will know what to do.

If you have problems getting an appointment or you are not sure what to do - please contact your family doctor for advice.

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FRACTURE CLINIC FOLLOW UP ADVICE

It is important that we have your correct address and phone number. Please check that these are correct on your discharge summary. Please tell the clerk, the nurse or the doctor so that we can correct them in our system.