Use of Sedation in the Management of Pediatric Proximal Phalanx Fractures
Suma Yalamanchili MD
Nathaniel Roberson MD
Shelby Kitchin BS
Maleeh Effendi MD
Brian Starr MD
Ann Schwentker MD
University of Cincinnati Medical Center
Presenter: Suma Yalamanchili MD
All work represents the original work of the residents/medical students listed.
Director Name: Ann Schwentker MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Purpose: The purpose of this study is to investigate the use of sedation in the management of pediatric proximal phalanx fractures treated at an academic pediatric hospital.
Background: Pediatric hand fractures are commonly managed non-operatively with closed reduction. As opposed to adults, pediatric patients may require sedation for closed reduction. There is a paucity of data on the use of sedation in the management of pediatric proximal phalanx fractures.
Methods: This is a retrospective chart review of pediatric proximal phalanx fractures treated at an academic pediatric hospital. This includes patients who were seen solely by emergency department providers or for whom consulting services such as plastic surgery or orthopedic surgery were consulted.
Results: 247 patients were identified. The average patient age was 11 years. The small finger was most commonly involved (42.9%), followed by the thumb (32.8%). No consulting service was called in the majority of patients (71.7%). 71 patients underwent closed reduction in the ED (28.7%). Sedation was involved in 26 patients (36.6%); 6 by the emergency department, 11 by plastic surgery, and 9 by orthopedic surgery. 214 patients had at least one clinic follow up. 8 patients underwent closed reduction in the clinic. 28 patients ultimately required operative intervention after clinic follow up.
Conclusions: The majority of patients who present to the emergency room with proximal phalanx fractures are not seen by a consulting hand service and no attempt at reduction is performed. However, when reduction is attempted, sedation is required in about one third of patients.
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