Reduction of forearm diaphyseal fractures in children under haematoma block in emergency: A prompt and cost-effective approach

Abstract

Introduction: Closed reduction of a diaphyseal forearm fracture, either radius or ulna, under haematoma block in the emergency department has been demonstrated to pro¬vide cost-effective, timely care. There has not been a considerable amount of research into the efficacy of haematoma or regional block and reducing such fracture types. This study describes the ep¬idemiology and outcomes associated with closed reduction of the fractures of either radius or ulnar diaphysis under haematoma block in our hospital's emergency department for the age group 5-11yrs. Methods: All children (5-11yrs old) with either radius or ulnar diaphysis fractures presenting to our hospital's emergency between July 2019 and January 2020 were included in our study. Patients were followed up for 1year records were maintained to determine diagnoses, treatments, and outcomes. The rate of repeat in¬tervention after successful reduction under haematoma block and rate of changes in management and the need for reduction under procedural sedation and further surgical intervention after morning case review rounds was calculated. Results: Closed reduction under haematoma block was performed on a total of 20 patients covering these fracture types during our study, with both bone forearm diaphyseal fractures (n = 14, 70%) comprising the majority of cases. A total of 4 cases (20%) lost alignment and required repeat inter¬vention, consisting of 3 cases (15%) that required repeat surgery and 1 (5%) that required cast wedg¬ing. There was one case of malunion noted (5%). Conclusions: Closed reduction under haematoma block provides an alternative to general anaesthesia for many paediatric trauma injuries without compromising patient outcomes.