Possibility of Avoiding Anesthesia in the Reduction of Greenstick and Angulated Forearm and Distal-End Radius Fractures in Children: A Comparative Study

Abstract

Introduction Greenstick and angulated forearm bone fractures are the most common fractures in children and invariably require closed reduction under anesthesia. However, pediatric anesthesia is somewhat risky and not always available in developing countries like India. Therefore, this study aimed to evaluate the standard (quality) of closed reduction without anesthesia in children and to determine satisfaction among parents. Materials and methods The present study included 163 children with closed angulated fractures of the distal radius and fracture shafts of both forearm bones, who were treated by closed reduction. One hundred and thirteen were treated without any anesthesia (study group) on an outpatient department (OPD) basis, whereas 50 children of similar age and fracture type underwent reduction with anesthesia (control group). After reduction by both methods check X-ray was done to evaluate the quality of the reduction. Results The average age of the 113 children in the present study was 9.5 years (range: 3.5-16.2 years), of which 82 children had radius or ulna fractures, and 31 had isolated distal radius fractures. In 96.8% of children, ≤10° of residual angulation was achieved. Furthermore, 11 children (12.4%) used paracetamol or ibuprofen for pain control in the study group. Moreover, 97.3% of parents stated that they would like their children to be treated without anesthesia if any fracture occurred again. Conclusions Closed reduction of greenstick angulated forearm and distal-end radius fracture in children in the OPD without anesthesia achieved satisfactory reduction and high parent satisfaction while reducing the risks of pediatric anesthesia and its associated complications.

Keywords: anaesthesia; children; closed reduction; fracture angulation; greenstick fracture.

Figure 1. Study design

Figure 2. Pre-reduction and post-reduction X-rays of forearm fracture.

(A) Pre-reduction X-ray showing greenstick fracture radius ulna. (B) Post-reduction X-ray. (C) Pre-reduction X-ray showing angulated fracture radius ulna. (D) Post-reduction X-ray. (E) Pre-reduction X-ray showing angulated fracture distal radius ulna. (F) Post-reduction X-ray.

Figure 3. Pre-reduction and post-reduction X-rays of forearm fracture

(A, B) Pre-reduction X-ray of forearm showing greenstick fracture distal radius. (C) Clinical picture showing deformity at wrist. (D) Post-reduction X-ray showing satisfactory alignment.