SAQ 203 – Orthopaedics and Toxicology – wrist fractures and local anaesthetic toxicity

Question 1. wrist fractures and local anaesthetic toxicity.

a. X-ray findings

• Distal-radius fracture: transverse, impacted, dorsally angulated, and extra-articular.
• Scaphoid-waist fracture.

b. Patient-related contraindications

• Refusal to consent.
• Unable to cooperate with the procedure.
• Compound injury or skin breach.
• Uncontrolled hypertension.
• Prilocaine allergy.
• Unable to obtain IV access in the dorsum of the hand.
• Raynaud syndrome.
• Buerger disease.

c. Drug and dose

• Prilocaine 0.5%, 1 mL/kg, to a maximum of 3 mg/kg.

d. Toxicity management

• Check and reinflate the tourniquet cuff.
• Stop local-anaesthetic administration.
• Treat the seizure with a benzodiazepine.
• Administer IV lipid emulsion.
• Consider haemodialysis.

e. Potential errors

• Tourniquet cuff failure or leak.
• Failure to inflate the cuff above an adequate pressure.
• Incorrect prilocaine dose.
• Incorrect local anaesthetic choice, such as lignocaine.
• Inadvertent administration of the wrong medication.