Anteromedial Ankle Hematoma Block

Mechanism of action of Hematoma Block

1. Local anesthetic (LA) is injected directly into the fracture hematoma, spreading the contents to the fracture site and the immediate local environment.
2. This LA targets the nerve fibers (especially small unmyelinated) in the periosteum and surrounding tissues.

Indications of Anteromedial Portal Injection

1. Aspiration: Septic arthritis, Gout
2. Aspiration and hematoma block: Reduction of ankle fractures

Landmarks

1. Medial malleolus
2. Medial axilla of tibial plafond
3. Tibialis anterior tendon

Technique

1. Supine position
2. Aseptic precautions
3. Mark the landmarks
4. Insert the needle at tibiotalar joint line between medial malleolus and tibialis anterior tendon
5. Aspirate hematoma
6. Inject 1% lidocaine without epinephrine in pre-determined dose