Reduction of forearm fractures in children using axillary block anesthesia

One hundred eleven patients (age range 15 months-16 years, mean 9.6 years) with displaced forearm fractures who had axillary blocks performed by orthopaedists in the emergency room were retrospectively reviewed. Thirty-seven fractures involved the distal radius, 56 involved both bones of the forearm, and 12 involved the physis of the distal forearm. Three Monteggia fractures, one radial neck fracture, one olecranon with an associated radial neck fracture, and one distal radius fracture with an associated elbow dislocation also were included. Of the 111 axillary blocks, 105 were rated as effective. Potential complications of axillary block anesthesia (systemic toxicity, hematoma, infection, and brachial neuralgia) were not observed in this group of patients. The cost of axillary block reduction in the emergency room was less than one third that of general anesthesia in the operating room. Axillary block anesthesia is reliable, safe, and cost effective, and this study supports its use by orthopaedists in displaced forearm fractures in children.