title: A comparison of pediatric forearm fracture reduction between conscious sedation and general anesthesia.
abstract: OBJECTIVE
  The purpose of this study was to compare the outcomes of children whose fractures were manipulated with nitrous oxide with those fractures manipulated under a general anesthetic.
  
  
  METHODS
  We undertook a retrospective analysis of all children who presented to the emergency department with an angulated or displaced nonphyseal forearm fracture requiring manipulation over a 6-month period.
  
  
  METHODS
  Twenty-eight forearm fractures were manipulated using conscious sedation, whereas 27 were manipulated in the operating theatre under general anesthesia.
  
  
  METHODS
  The quality of reduction, the Cast Index, Padding Index, and Canterbury Index were similar between the 2 groups.
  
  
  RESULTS
  There was a significant difference between the need for remanipulation in the nitrous oxide group (9) compared with the need for remanipulation in the theatre group (3).
  
  
  CONCLUSIONS
  Despite a higher failure, manipulation of fractures in the emergency department using conscious sedation can achieve an adequate reduction and a high quality of cast. Failures were due to inherently more unstable fracture personalities.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, Children's University Hospital, Temple Street, Dublin, Ireland. paulbmckenna@gmail.com
authors.forename: Paul
authors.initials: P
authors.lastname: McKenna
authors.forename: Mike
authors.initials: M
authors.lastname: Leonard
authors.forename: Paul
authors.initials: P
authors.lastname: Connolly
authors.forename: Sinead
authors.initials: S
authors.lastname: Boran
authors.forename: Damian
authors.initials: D
authors.lastname: McCormack
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D005260:Female; D005543:Forearm Injuries / Q000628:therapy*; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic; D009609:Nitrous Oxide; D011885:Radius Fractures / Q000628:therapy*; D012189:Retrospective Studies; D014458:Ulna Fractures / Q000628:therapy*
chemical_list: D009609:Nitrous Oxide