Distal forearm fractures are commonly seen in the Emergency Department (ED) and primarily involve the distal radius and ulna [[1], [2], [3]]. Notably, distal radius fractures alone account for up to 46 % of all skeletal fractures observed in the primary care setting [3,4]. As distal radius fractures are considered osteoporotic fractures, their incidence will increase with the ageing population. The majority of distal forearm fractures are treated nonoperatively with plaster cast immobilisation. Of these, up to half require closed reduction to ensure better union and functional outcome [5,6]. This is a painful procedure, and adequate analgesia is of utmost importance, both for improving patient experience and achieving optimal clinical outcome [7]. 

There are several methods for analgesia in these patients, including general anaesthesia, procedural sedation and analgesia, intravenous (local) analgesia, peripheral nerve blocks and local analgesia such as the fracture hematoma block (FHB) [[7], [8], [9]]. Among these options, the latter is commonly used in the Netherlands and is recommended by the current Dutch trauma guideline [10]. Interestingly, whether this method is superior remains uncertain and open to debate [7]. While FHB is recognized as a painful procedure with variable success rates and outcomes influenced by physicians' expertise, time constraints and fracture type, alternative analgesic options such as procedural sedation or general anaesthesia are time-intensive procedures, require costly resources, and pose potential adverse effects and risks to the patient [7,11,12].

As ultrasound machines are widely available and used in EDs nowadays, ultrasound-guided nerve blocks are becoming an increasingly common feature of emergency medicine practice and training. Ultrasound-guided peripheral nerve blocks for pain control may represents a feasible, superior alternative with a low rate of adverse effects and complications when performed in the ED [[13], [14], [15]]. A recent study comparing ultrasound-guided peripheral nerve blocks with FHB found a significant reduction in pain perception, particularly with the axillary nerve block (ANB) [16]. Other studies on hand and wrist surgery showed high success rates for analgesia trough a ANB during surgery [17,18]. These high success percentages suggest that an ANB may be superior to a FHB in fracture reduction. However, evidence on using a ANB in the emergency department for fracture reductions remains scarce and factors as the time to perform the blocks adequately and likelihood of requiring a second reduction attempt are vital to take into account in a crowded ED.

The primary goal of our study is to evaluate the superiority of the ultrasound-guided ANB compared to the standard of care, FHB, for analgesia during closed reduction of distal forearm fractures. Secondary objectives include assessing the feasibility in the ED, focusing on procedural time, and evaluating patient-centered outcomes, such as procedural success rate and satisfaction of both patients and physicians.