Wrist Fracture in Emergency Medicine Medication
- Author: Bryan C Hoynak, MD, FACEP, FAAEM; Chief Editor: Trevor John Mills, MD, MPH more...
Drugs used to treat fractures include analgesics and anxiolytics. In addition, proper antibiotics must be administered for open fractures.
Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Most analgesics have sedating properties that benefit patients who have sustained traumatic injuries.
Propoxyphene products were withdrawn from the United States market on November 19th, 2010. The withdrawal was based on new data showing QT prolongation at therapeutic doses. For more information, see the FDA MedWatch safety information.
Short duration (30-60 min), ease of titration, and rapid and easy reversal by naloxone make this an excellent choice for pain management and sedation.
DOC for narcotic analgesia because of its reliable and predictable effects, safety, and ease of reversibility with naloxone. Administered IV, may be dosed in a number of ways and commonly is titrated until desired effect obtained.
Propoxyphene/acetaminophen (Darvocet N-100)
Propoxyphene was withdrawn from the US market. Drug combination indicated for treatment of mild to moderately severe pain.
Drug combination indicated for treatment of mild to moderately severe pain.
Drug combination indicated for relief of moderately severe to severe pain.
Patients with painful injuries usually experience significant anxiety. Anxiolytics allow a smaller analgesic dose to achieve the same effect.
Sedative hypnotic in benzodiazepine class that has short onset of effect and relatively long half-life. By increasing action of GABA, a major inhibitory neurotransmitter, may depress all levels of CNS, including limbic and reticular formation.
Indicated for treatment of anxiety and management of panic attacks.
DOC for acute sedation/anxiety as adjuvant for reduction of acute fracture/dislocations. Titratable effect and anterograde amnesia for 1-2 h make this an ideal agent. Onset of action within 2 min, and effective duration of action 30 min IV and 45 min IM.
Steinberg MD. Acute wrist injuries in the athlete. Ortho Clin N Am. 2002. 33:535-545.
Bishop AT, Beckenbaugh RD. Fracture of the hamate hook. J Hand Surg Am. 1988 Jan. 13(1):135-9. [Medline].
Whalen JL, Bishop AT, Linscheid RL. Nonoperative treatment of acute hamate hook fractures. J Hand Surg Am. 1992 May. 17(3):507-11. [Medline].
Yin ZG, Zhang JB, Kan SL, Wang P. Treatment of acute scaphoid fractures: systematic review and meta-analysis. Clin Orthop Relat Res. 2007 Jul. 460:142-51. [Medline].
Kukla C, Gaebler C, Breitenseher MJ, Trattnig S, Vecsei V. Occult fractures of the scaphoid. The diagnostic usefulness and indirect economic repercussions of radiography versus magnetic resonance scanning. J Hand Surg Br. 1997 Dec. 22(6):810-3. [Medline].
Raby N. Magnetic resonance imaging of suspected scaphoid fractures using a low field dedicated extremity MR system. Clin Radiol. 2001 Apr. 56(4):316-20. [Medline].
Amarani KK. Diagnosing radiographically occult scaphoid fractures: what’s the best second test? Journal of the American Society for Surgery of the Hand. 2005. 5(3):134-8.
Breitenseher MJ, Metz VM, Gilula LA, et al. Radiographically occult scaphoid fractures: value of MR imaging in detection. Radiology. 1997 Apr. 203(1):245-50. [Medline].
Carpenter CR, Pines JM, Schuur JD, Muir M, Calfee RP, Raja AS. Adult scaphoid fracture. Acad Emerg Med. 2014 Feb. 21(2):101-21. [Medline].
Behzadi C, Karul M, Henes FO, Laqmani A, Catala-Lehnen P, Lehmann W, et al. Comparison of conventional radiography and MDCT in suspected scaphoid fractures. World J Radiol. 2015 Jan 28. 7(1):22-7. [Medline]. [Full Text].
Khan S, Sawyer J, Pershad J. Closed Reduction of Distal Forearm Fractures by Pediatric Emergency Physicians. Acad Emerg Med. 2010 Nov. 17(11):1169-1174.
Ang SH, Lee SW, Lam KY. Ultrasound-guided reduction of distal radius fractures. Am J Emerg Med. 2010 Nov. 28(9):1002-8. [Medline].
Garcia-Elias M. Carpal instabilities and dislocations. Green’s operative hand surgery. 4th addition. New York: Churchill Livingstone; 1999. P 865-928.
Brown DE, Lichtman DM. Midcarpal instability. Hand Clin. 1987 Feb. 3(1):135-40. [Medline].
Okazaki M, Tazaki K, Nakamura T, Toyama Y, Sato K. Tendon Entrapment in Distal Radius Fractures. J Hand Surg Eur Vol. 2009 Mar 25. [Medline].
Caillit R. Hand Pain and Impairment. FA Davis and Company; 1975.
DePalma. Management of Fractures and Dislocations. WB Saunders and Company; 1970.
Hoppenfeld S. Physical Examination of the Spine and Extremities. Appleton-Century-Croft Publishing; 1976.
Papp S. Carpal bone fractures. Orthop Clin North Am. 2007 Apr. 38(2):251-60, vii. [Medline].
Plint AC, Perry JJ, Correll R, Gaboury I, Lawton L. A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children. Pediatrics. 2006 Mar. 117(3):691-7. [Medline].
Resnick D, Kang H. Internal Derangement of Joints. WB Saunders and Co; 1997.
Rockwood C, Green D. Fractures in Adults. Lippincott and Co; 1996.
Simon R, Coenigskecht S. Orthopedics in Emergency Medicine. Appleton-Century and Kross Publishing; 1982.
Tintinalli J, Ruiz E, Krome R. Emergency Medicine: A Comprehensive Study Guide. 4th ed. McGraw-Hill Publishing; 1996.