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It’s the Bier out here

Whistler doctors find century-old method works best for setting wrists

If you break a wrist Whistler is the place to have it fixed.

In an upcoming article in Canadian Journal of Emergency Medicine , local physician Bruce Mohr looks at how Whistler physicians are using a century-old method in combination with new technology to keep patients pain-free and alert while having complex wrist fractures set in place.

“If somebody comes in with a hand or wrist or forearm injury there’s several ways to look after them in terms of if the bones are dislocated, broken or out of place,” Mohr said. But one method first used almost 100 years ago seems to work the best.

With data collection assistance from registered nurse Janet Hamer, Mohr examined the Bier block method, one of four available treatments for complex wrist fractures used at the Whistler Health Care Centre from September, 2000 to March, 2005 in terms of effectiveness and risk. He found the Bier block method, first used by German surgeon August Bier, to be the most effective. (Bier also pioneered the use of spinal anaesthetic.)

Dr. Mohr, who studied at the Universities of Ottawa and Calgary, examined how Whistler doctors currently use the Bier block method, which was first employed in 1908 to isolate injured wrists so that injected anaesthetic doesn’t travel elsewhere in the body.

Whistler doctors see as many as 13 complex wrist fractures a day in winter months. In the five-year of the study alone Mohr found the clinic’s physicians treated 1,816 wrist injuries using the Bier block method with patients ranging in age from four to 70.

Other methods available include a more painful injection of local anaesthetic into the fracture site, intravenously sedating patients, regional nerve blocks (without a tourniquet) and general anaesthetic, the last of which is only an option for operating rooms in hospitals.

Mohr said the other options all have limitations, but the Bier block method — which uses an upper arm pneumatic tourniquet to isolate the lower arm from the rest of the body in conjunction with a local anaesthetic and a mini portable C-arm X-ray — takes the guesswork out of setting fractures. Funding for the bedside X-ray machine was donated by local charities through the Whistler Health Care Foundation.

Efficiency is also a consideration for a clinic like Whistler, which cared for 206 patients with complex forearm injuries in a three-month period in winter, 2005. That number doesn’t include hand and thumb fractures or wrist fractures that didn’t require bone setting.

Mohr says his 1,200-word article for the July 2006 Canadian Journal of Emergency Medicine, titled Safety and effectiveness of intravenous regional anaesthesia (Bier block) for outpatient management of forearm trauma, is important because to his knowledge it is the largest published study of the Bier block method to date.

“And there hasn’t been a study done of this technique used by primary care [non-specialists] physicians in a rural, non-hospital setting,” he said.

Whistler’s extreme sporting demographics provide local doctors with a large sampling of numbers of injuries with which to study, he said. Whistler health care centre deals with more trauma than Vail, Colorado or Banff, both of which have full-service hospitals. The centre saw over 23,000 emergency room visits in 2004.