Fracture manipulation in the emergency department often requires some method of anesthesia. This study evaluates the efficacy and safety of the hematoma block in patients with closed, isolated fractures requiring manipulative reduction. Sixty-one patients treated with a hematoma block (HB group) prior to fracture manipulation were compared with 53 patients treated with either intravenous sedation or "conscious sedation" (NHB group). Using a pain analog scale, patients rated their pain from 1 (no pain) to 10 (severe pain) both prior to and during fracture manipulation. A pain differential score was calculated for each group. Results demonstrated pain differential scores of 2.7 and 0.8 for the HB and NHB groups, respectively. There were no complications associated with any of the procedures. Based on these results, we conclude that the hematoma block is an effective and safe method of providing anesthesia for fracture reduction in select patients.