Use of ketamine sedation for the management of displaced paediatric forearm fractures

作     者：Anatole Vilhelm Wiik Poonam Patel Joanna Bovis Adele Cowper Philip Socrates Pastides Alison Hulme Stuart Evans Charles Stewart 

作者机构：Department of Surgery and Cancer Charing Cross Hospital Department of Paediatric Emergency Chelsea and Westminster Hospital Department of Trauma and Orthopaedics Chelsea Westminster Hospital 

出 版 物：《World Journal of Orthopedics》 (世界骨科杂志（英文版）)

年 卷 期：2018年第9卷第3期

页      面：50-57页

学科分类：10[医学] 

主　　题：Paediatrics Forearm fractures Displaced fractures Ketamine Salter Harris Procedural sedation 

摘      要：AIM To determine if ketamine sedation is a safe and cost effective way of treating displaced paediatric radial and ulna fractures in the emergency department. METHODS Following an agreed interdepartmental protocol, fractures of the radius and ulna(moderately to severely displaced) in children between the age of 2 and 16 years old, presenting within a specified 4 mo period, were manipulated in our paediatric emergency department. Verbal and written consent was obtained prior to procedural sedation to ensure parents were informed and satisfied to have ketamine. A single attempt at manipulation was performed. Pre and postmanipulation radiographs were requested and assessed to ensure adequacy of reduction. Parental satisfaction surveys were collected after the procedure to assess the perceived quality of treatment. After closed reduction and cast immobilisation, patients were then followed-up in the paediatric outpatient fracture clinic and functional outcomes measured prospectively. A cost analysis compared to more formal manipulation under a general anaesthetic was also *** During the 4 mo period of study, 10 closed, moderate to severely displaced fractures were identified and treated in the paediatric emergency department using our ketamine sedation protocol. These included fractures of the growth plate(3), fractures of both radius and ulna(6) and a single isolated proximal radius fracture. The mean time from administration of ketamine until completion of the moulded plaster was 20 min. The mean time interval from sedation to full recovery was 74 min. We had no cases of unacceptable fracture reduction and no patients required any further manipulation, either in fracture clinic or under a more formal general anaesthetic. There were no serious adverse events in relation to the use of ketamine. Parents, patients and clinicians reported extremely favourable outcomes using this technique. Furthermore, compared to using a manipulation under general anaesthes