Wiik AV, Patel P, Bovis J, Cowper A, Pastides PS, Hulme A, Evans S, Stewart C. Use of ketamine sedation for the management of displaced paediatric forearm fractures. World J Orthop 2018; 9(3): 50-57 [PMID: 29564214 DOI: 10.5312/wjo.v9.i3.50]
Corresponding Author of This Article
Anatole Vilhelm Wiik, BSc, MBBS, MD, Doctor, Lecturer, Department of Surgery and Cancer, Charing Cross Hospital, Fulham Place Road, London W6 8RF, United Kingdom. a.wiik@imperial.ac.uk
Research Domain of This Article
Orthopedics
Article-Type of This Article
Clinical Practice Study
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Wiik AV, Patel P, Bovis J, Cowper A, Pastides PS, Hulme A, Evans S, Stewart C. Use of ketamine sedation for the management of displaced paediatric forearm fractures. World J Orthop 2018; 9(3): 50-57 [PMID: 29564214 DOI: 10.5312/wjo.v9.i3.50]
World J Orthop. Mar 18, 2018; 9(3): 50-57 Published online Mar 18, 2018. doi: 10.5312/wjo.v9.i3.50
Use of ketamine sedation for the management of displaced paediatric forearm fractures
Anatole Vilhelm Wiik, Poonam Patel, Joanna Bovis, Adele Cowper, Philip Socrates Pastides, Alison Hulme, Stuart Evans, Charles Stewart
Anatole Vilhelm Wiik, Department of Surgery and Cancer, Charing Cross Hospital, London W6 8RF, United Kingdom
Poonam Patel, Adele Cowper, Charles Stewart, Department of Paediatric Emergency, Chelsea and Westminster Hospital, London SW10 9NH, United Kingdo
Joanna Bovis, Philip Socrates Pastides, Alison Hulme, Stuart Evans, Department of Trauma and Orthopaedics, Chelsea Westminster Hospital, London SW10 9NH, United Kingdom
Author contributions: Wiik AV and Stewart C designed the study; Wiik AV and Stewart C collected the data; Wiik AV, Patel P, Bovis J and Cowper A analysed the results; Wiik AV, Patel P, Bovis J, Cowper A, Pastides PS, Hulme A, Evans S and Stewart C interpreted and wrote the report.
Institutional review board statement: This was a registered service improvement project at Chelsea Westminster hospital audit department (QIP LA-353). Ethical approval was not sought nor required as it was part of a service evaluation project for the paediatric emergency department at Chelsea Westminster hospital.
Informed consent statement: Informed consent was obtained prior to any treatment from the parent or guardian.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Data sharing statement: Dataset available from the corresponding author.
Correspondence to: Anatole Vilhelm Wiik, BSc, MBBS, MD, Doctor, Lecturer, Department of Surgery and Cancer, Charing Cross Hospital, Fulham Place Road, London W6 8RF, United Kingdom. a.wiik@imperial.ac.uk
Telephone: +44-20-33130970 Fax: +44-20-33115218
Received: November 3, 2017 Peer-review started: November 4, 2017 First decision: December 27, 2017 Revised: January 4, 2018 Accepted: February 4, 2018 Article in press: February 5, 2018 Published online: March 18, 2018 Processing time: 132 Days and 12.4 Hours
ARTICLE HIGHLIGHTS
Research background
Children forearm fractures account for up to 40% of fractures that present to the emergency department (ED), majority which could be managed there.
Research motivation
This study improved the quality of care given to children with deformed forearm fractures in the ED.
Research objectives
The main aim of this quality improvement project was to determine if ketamine sedation is a safe and cost-effective way of treating deformed paediatric forearm fractures in the ED.
Research methods
Over a set 4 mo period we prospectively evaluated a new ketamine protocol for paediatric ED procedural sedation. All eligible children with significantly displaced or unstable fractures of the radius and ulna that presented during daylight weekday hours that needed closed reduction and moulded casting were included.
Research results
A total of 10 forearm fractures with a mean 45° angulation deformity were definitively treated in the ED with ketamine procedural sedation. The cost saving was £1470 for each child compared if the patient was taken to theatre. Overall mean parental satisfaction was 9.6 out of 10.
Research conclusions
Ketamine procedural sedation in the paediatric population is a safe and cost effective method for the treatment of displaced forearm fractures.
Research perspectives
Majority of paediatric forearm fracture, irrespective of displacement, can be treated in the ED as long as the fracture pattern is reducible and can be maintained safely in a moulded cast for the duration of its healing.
