Fracture manipulation management for RHC ED

Box A – Fractures appropriate for manipulation in ED must meet both inclusion criteria and have no exclusion criteria.

Inclusion

• Simple fracture which is angulated or partly displaced. (any degree of angulation can be considered)
• The fracture is easily reducible with a simple reduction manoeuvre, preferably at the first attempt

Exclusion

• Off-ended distal radius fractures (in the absence of NV compromise)
• Complex reduction manoeuvres are likely required

Box B

The decision to use IV ketamine sedation is that of the emergency department consultant and nurse in charge and the following factors should be taken into consideration:

Time of day, Safe staffing levels, Staff skill mix, Age of patient, Contraindications

Consider portable “hot” XR in resus whilst patient still under sedation to check position post manipulation.

Ketamine for PPS SOP