Pediatric fracture reduction in the emergency department

Limb fractures are a large part of pediatric trauma activity. Conservative treatment is possible because of children's bone remodeling potential. In case of displaced fractures, when a closed reduction can be done in the emergency room (ER), this avoids general anesthesia, hospitalization and the associated costs. In well-defined situations, there is a consensus about the indication for fracture reduction in the ER. Some complex fracture cases require immediate treatment in the operating room: intra-articular fractures, pathological fractures, fractures with associated skin, nerve or vascular injuries and/or early signs of compartment syndrome. And last, there is another set of fractures where the indication is not so clear. To specify the indications and technical implementation of these treatments in ER, we did a non-systematic narrative review of literature in the MEDLINE® database using the PubMed search engine to query "emergency room AND children AND fracture AND reduction". We retained the most recent articles addressing the questions related to indications and their care, sedation protocol and complications. The sedation protocol for the ER is established collaboratively by surgical, ER and anesthesia teams. The residual angulation that can be tolerated after reduction depends on the patient's age, remaining growth potential and location of the fracture line. When reduction is done in the ER, the complication and secondary displacement rates are not higher, although surgeon experience and specific procedural training appear to be crucial.