• Paul McKenna, Mike Leonard, Paul Connolly, Sinead Boran, and Damian McCormack.
• Department of Orthopaedics, Children's University Hospital, Temple Street, Dublin, Ireland. paulbmckenna@gmail.com
• J Orthop Trauma. 2012 Sep 1;26(9):550-5; discussion 555-6.

ObjectivesThe purpose of this study was to compare the outcomes of children whose fractures were manipulated with nitrous oxide with those fractures manipulated under a general anesthetic.DesignWe undertook a retrospective analysis of all children who presented to the emergency department with an angulated or displaced nonphyseal forearm fracture requiring manipulation over a 6-month period.Patients/ParticipantsTwenty-eight forearm fractures were manipulated using conscious sedation, whereas 27 were manipulated in the operating theatre under general anesthesia.Main Outcome MeasurementsThe quality of reduction, the Cast Index, Padding Index, and Canterbury Index were similar between the 2 groups.ResultsThere was a significant difference between the need for remanipulation in the nitrous oxide group (9) compared with the need for remanipulation in the theatre group (3).ConclusionsDespite a higher failure, manipulation of fractures in the emergency department using conscious sedation can achieve an adequate reduction and a high quality of cast. Failures were due to inherently more unstable fracture personalities.Level Of EvidenceTherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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