Manipulation Of Paediatric Wrist Fractures Without Portable X-Ray In The Emergency Department

The purpose of this study was to evaluate the early outcome following the manipulation of distal radius and ulna fractures under ketamine sedation in paediatric patients.Patients presenting with fractures of the distal radius and ulna and manipulated in the Emergency department (ED) were identified from the ED databases and retrospectively reviewed. 40 children were identified. No patient had neurovascular (NV) symptoms prior to manipulation under anaesthetic (MUA). No patients required admission for complications related to ketamine sedation following MUA. Fracture angulation improved significantly. 4 patients required admission for repeat MUA +/- K-wire stabilisation/open reduction internal fixation (ORIF) due to failure of reduction. There were no neurological/vascular complications on discharge. All patients had made excellent functional recovery on discharge. Manipulation of paediatric forearm fractures under ketamine is safe. Excellent radiological and clinical results were noted for the majority of patients. Most requiring further operative intervention were all completely displaced on radiographs in two orthogonal views. We therefore highlight a fracture pattern that is not suitable for MUA in the absence of portable x-ray.