Abstract
The aim was to compare the efficacy and outcomes of reduction of closed forearm fractures in a paediatric population using Ketamine in the Emergency Department (ED) setting versus reduction under general anaesthesia (GA) in the operating theatre (OT).
A prospective audit of children presenting to our institution with closed fractures of the radius and/or ulna was conducted. Patients presenting to ED were offered manipulation under GA or Ketamine, and then grouped accordingly. Children were followed up until full range of motion had recovered. Outcomes measured at follow up were 1) need for remanipulation, 2) position at union, 3) total hospital stay and 4) functional outcome.
Forearm fractures account for 22% of acute paediatric orthopaedic admissions to our institution. 70% require manipulation and splintage. 221 forearm fractures required manipulation during the study period. 90 patients (41%) were manipulated under Ketamine in the ED, 131 patients (59%) were manipulated in the OT. There was no significant difference in mean angulation of fractures treated by either method (p=0.20). There was no significant difference between the two methods with respect to rates of remanipulation (p=0.73) or poor position at union (p=0.55). There was a significantly shorter hospital stay for those treated in the ED.
Treatment of paediatric forearm fractures in the ED under Ketamine sedation offers an effective alternative for selected fractures. It also offers considerable financial savings and is less of a drain on valuable theatre and staff resources.
The abstracts were prepared by Editorial Secretary Jean-Claude Theis. Correspondence should be addressed to NZOA at Department of Orthopaedic Surgery, Dunedin Hospital, Private Bag 1921, Dunedin, New Zealand.
