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Children's Orthopaedics

A PROSPECTIVE STUDY OF THE MANIPULATION AND THE REDUCTION OF PAEDIATRIC FRACTURES OF THE FOREARM AND DISTAL RADIUS IN THE EMERGENCY ROOM VERSUS IN THE OPERATING THEATRE

The British Society for Children' s Orthopaedic Surgery (BSCOS) and the Swedish Paediatric Orthopaedic Society (SBOF), Combined Meeting, March 2017



Abstract

Purpose

To assess outcomes of manipulating upper extremity fractures with conscious sedation compared with formal reduction and casting in theatre under general anaesthesia and image intensifier control.

Method

Prospective six month period all patients presenting to the Emergency Department with a both bone forearm or distal radial fracture that was deemed suitable for closed reduction and casting where included in the study. All fractures deemed to require instrumentation were excluded.

Results

We identified 56 fractures, 13 of the distal radius and 43 both bone forearm. 22 where treated in theatre with 34 treated in ED. Age range 2–14 years. We had 1 re fracture in the ED group and 1 re fracture in the theatre group. All fractures united within acceptable limits. We had no re operations in either group. No complications from the procedural sedation or anaesthesia. Mean time to treatment in theatre group was 18 hours Vs 3 hours in the ED group (P< 0.05).

Conclusion

The use of procedural sedation, closed reduction and casting has no adverse effects on union, malunion, reoperation or anaesthetic complications. It is however significantly quicker, significantly lower in cost when compared with admission and treatment in theatre and has less negative psychological impact on the child. We recommend treatment in Emergency Department for all fractures of the forearm and distal radius that can be managed by closed reduction and casting in children who are safe to undergo procedural sedation.