343 Distal Radius Fracture Emergency Analgaesia and Management Audit

Aim To audit analgesia used in the initial management of patients with Distal Radius Fractures (DRFs) that require manipulation against the current standards. Method Standards used were 2018 British Society for Surgery to the Hand (BSSH) guidelines, which recommend intravenous regional anaesthesia and haematoma blocks when manipulating DRFs. Data collection using survey dissemination at 2 tertiary centres included adult patients presenting between 13/08/2022 and 26/11/2022 with DRFs. Exclusion criteria were open fractures, multiple fractures and major trauma. Patient factors and management, with corresponding pain Visual Analogue Scale (VAS) before, during and post manipulation were recorded. Imaging was reviewed to determine radiographic measurements on presentation and in clinic. Data was recorded using REDCap database. Results There were 33 mostly female (F:M 29:4) patients included. Only 24.24% had no co-morbidities. Comorbidities included Hypertension (42.42%), Ischaemic Heart Disease (24.24%) and Asthma (21.21%). Most patients (87.88%) received Methoxyflurane (Penthrox), the remainder had Lidocaine haematoma block. Manipulations were mostly performed by staff from A+E (63.64%). Increased pain scores during manipulation were reported in 64.29% of patients, with a median increase of 7 points. Decreased post manipulation scores were reported in 87.10% with a median decrease of 16 points. Further manipulation was required in 27.27%. Operative fixation was required in 21.21%. Conclusions In conclusion the current guidelines are not being followed in the centres we audited. Methoxyflurane was used for the majority of patients, with good outcomes. Further data is required from multiple centres across the UK to assess whether guidelines need to be updated.