Morrison Todd, Carender Chris, Kilbane Brendan, Liu Raymond W
Orthopedics. 2017 Sep 1;40(5):288-294. doi: 10.3928/01477447-20170824-01. Epub 2017 Sep 7.
Effective treatment of pediatric both bone forearm fractures consists of timely restoration of anatomic alignment with manipulation and immobilization, often accomplished with the aid of procedural sedation in the emergency department setting. The current lack of consensus regarding a safe and optimal regimen may result in inadequate sedation, compromised quality of reduction, or patient harm. The current study was conducted to answer the following questions for pediatric both bone forearm fractures treated with closed reduction with either ketamine or propofol procedural sedation: (1) Is there a difference in the rate of unacceptable alignment 4 weeks after reduction? (2) Is there a difference in the rates of major sedation-related complications? Medical records, data on procedural sedation, and radiographs of 74 skeletally immature patients with diaphyseal or distal metaphyseal both bone forearm fractures treated with manipulation were reviewed (ketamine sedation, 26; propofol sedation, 48). Rates of unacceptable alignment for the 2 cohorts were similar both immediately after reduction and at 4 weeks. Rates of complications of procedural sedation did not differ between cohorts. The duration of procedural sedation was longer and the padding index was greater with ketamine. Malalignment after reduction was more likely in older patients and those with a higher padding index. Although no difference was found in the rates of malalignment or sedation-related complications between fractures reduced with ketamine or propofol sedation, the sedation regimens differ in both procedural duration and padding index. Careful consideration of the risks and benefits of procedural sedation for closed reduction of pediatric forearm fractures is warranted. [Orthopedics. 2017; 40(5):288-294.].
小儿双侧尺桡骨骨折的有效治疗包括通过手法复位和固定及时恢复解剖对位，这通常在急诊科借助程序性镇静来完成。目前对于安全且最佳方案缺乏共识，可能导致镇静不足、复位质量受损或对患者造成伤害。本研究旨在回答以下关于采用氯胺酮或丙泊酚程序性镇静进行闭合复位治疗的小儿双侧尺桡骨骨折的问题：（1）复位后4周时，不可接受对位率是否存在差异？（2）主要镇静相关并发症的发生率是否存在差异？回顾了74例骨骼未成熟、因双侧尺桡骨干或远端干骺端骨折接受手法复位治疗患者的病历、程序性镇静数据及X线片（氯胺酮镇静组26例；丙泊酚镇静组48例）。两组在复位后即刻及4周时不可接受对位率相似。两组程序性镇静并发症发生率无差异。氯胺酮组程序性镇静持续时间更长，衬垫指数更高。年龄较大患者及衬垫指数较高者复位后更易出现对位不良。尽管采用氯胺酮或丙泊酚镇静复位的骨折在对位不良或镇静相关并发症发生率上未发现差异，但两种镇静方案在操作持续时间和衬垫指数方面有所不同。对于小儿前臂骨折闭合复位的程序性镇静，有必要仔细权衡其风险和益处。[《骨科学》。2017年；40（5）：288 - 294。]
