Comparison of Periosteal Block to. Biers Block (Intravenous Regional Anaesthesia) for the reduction of distal radius fractures

INTERVENTION: This is a single centre, prospective, randomized clinical trial with consecutive recruitment of adult patients (greater than or equal to 16 years) presenting to the Dunedin Emergency Department with a distal radius fracture requiring manipulation. Study Setting: Single Emergency Department Emergency Department Providers will undergo brief training in Periosteal Block (Arm 1) and IVRA (arm 2) for distal radius fractures. Training will be provided by study investigators. The procedure will be administered by the treating emergency physician. Arm 1: Periosteal block will be performed by treating ED physicians. The block will be performed with an injection of 15ml of 1% lidocaine Arm 2:IVRA (aka Biers Block) Performed using 3 ml/kg 0.5% Prilocaine CONDITION: distal radius fracture PRIMARY OUTCOME: We will compare of pain score using 100mm visual analogue scale (VAS) during manipulation for patients undergoing periosteal block to those undergoing Intravenous Regional Anaesthesia (IVRA). ; SECONDARY OUTCOME: (ii) re‐manipulation rates of the two techniques assessed by physician self reporting ; (iii) provider assessment of ease of performance of the periosteal block compared to IVRA. ; ; (v) comparison of adequate reduction rates for the two groups, Assessed by retrospective physician review of radiology imaging performed during initial ED visit iv) emergency department length of stay for the two groups. ; ; INCLUSION CRITERIA: Patients 16 years or older with a distal radius fracture undergoing closed reduction in the Emergency Department are eligible. This will include fractures where closed reduction is performed as definitive management and cases in which reduction is performed in the ED prior to definitive operative reduction and fixation.