Manipulation and reduction of paediatric fractures of the distal radius and forearm using intranasal diamorphine and 50% oxygen and nitrous oxide in the emergency department

Kurien, Thomas; Price, K.R.; Pearson, Richard G.; Hunter, J.B.

Abstract

A retrospective study was performed in 100 children aged between two and 16 years, with a dorsally angulated stable fracture of the distal radius or forearm, who were treated with manipulation in the emergency department (ED) using intranasal diamorphine and 50% oxygen and nitrous oxide. Pre- and post-manipulation radiographs, the final radiographs and the clinical notes were reviewed. A successful reduction was achieved in 90 fractures (90%) and only three children (3%) required remanipulation and Kirschner wire fixation or internal fixation.
The use of Entonox and intranasal diamorphine is safe and effective for the closed reduction of a stable paediatric fracture of the distal radius and forearm in the ED. By facilitating discharge on the same day, there is a substantial cost benefit to families and the NHS and we recommend this method.

Citation

Kurien, T., Price, K., Pearson, R. G., & Hunter, J. (in press). Manipulation and reduction of paediatric fractures of the distal radius and forearm using intranasal diamorphine and 50% oxygen and nitrous oxide in the emergency department. Bone and Joint Journal, 98B(1), https://doi.org/10.1302/0301-620X.98B1.36118

• Journal Article Type: Article
• Acceptance Date: Aug 17, 2015
• Online Publication Date: Jan 5, 2016
• Deposit Date: May 11, 2017
• Journal: Bone and Joint Journal
• Print ISSN: 2049-4394
• Electronic ISSN: 2049-4408
• Publisher: British Editorial Society of Bone and Joint Surgery
• Peer Reviewed: Peer Reviewed
• Volume: 98B
• Issue: 1
• DOI: https://doi.org/10.1302/0301-620X.98B1.36118
• Public URL: https://nottingham-repository.worktribe.com/output/773665
• Publisher URL: http://www.bjj.boneandjoint.org.uk/content/98-B/1/131