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Hematoma Block


  • Fracture reduction (most frequently distal radius or metacarpal fractures, in my practice)

My Usual Injection

  • 10 mL syringe

  • 8 mL 1% Lidocaine or .25% Marcaine without epinephrine

  • 22g 1 1/2 in needle


  1. Obtain, at least, verbal consent for procedure

  2. Palpate and identify the injection site, which should be directly over the fracture site, dorsally

  3. Mark with a skin marker or indent with pen cap, if desired

  4. Apply topical antibacterial to the site x 3

  5. Apply gloves, if not already done

  6. Apply topical analgesic, if desired

  7. Slowly and controlled, insert needle through skin at previously identified injection site and into the fracture

  8. Once you get a bloody flash you are in the fracture hematoma

  9. Slowly inject anesthetic into the fracture

10. Withdraw needle

11. Wipe area clean

11. Apply bandage

12. Wait for anesthetic effect before beginning reduction procedure (Usually within 5 minutes)

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