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Fracture manipulation management for RHC ED

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Box A – Fractures appropriate for manipulation in ED must meet both inclusion criteria and have no exclusion criteria.


  • Simple fracture which is angulated or partly displaced. (any degree of angulation can be considered)
  • The fracture is easily reducible with a simple reduction manoeuvre, preferably at the first attempt


  • Off-ended distal radius fractures (in the absence of NV compromise)
  • Complex reduction manoeuvres are likely required

Box B

The decision to use IV ketamine sedation is that of the emergency department consultant and nurse in charge and the following factors should be taken into consideration:

Time of day, Safe staffing levels, Staff skill mix, Age of patient, Contraindications

Consider portable “hot” XR in resus whilst patient still under sedation to check position post manipulation.

Ketamine for PPS SOP

Editorial Information

Last reviewed: 01 February 2022

Next review: 28 February 2025

Author(s): Dr Gillian Campbell - Consultant in Paediatric Emergency Medicine, RHCG on behalf of RHCG ED. Correspondence author: Dr Steve Foster.

Version: 4

Co-Author(s): Stakeholder: Miss Alexandra Smith, Consultant Paediatric Orthopaedic Surgeon, RHCG - on behalf of Paediatric Orthopaedic services RHCG

Approved By: RHCG ED & Paediatric Orthopaedic services RHCG