Sternal fractures are predominantly associated with deceleration injuries and blunt anterior chest trauma. Sternal trauma must be carefully evaluated by monitoring of vital parameters and it is of paramount importance that concomitant injuries are excluded. Nevertheless, routine admission of patients with isolated sternal fractures for observation is still common in today's practice, which is often unnecessary. This article aims to describe the prognosis, the recommended assessment and management of patients with sternal fractures, to help clinicians make an evidence-based judgment regarding the need for hospitalization.

The definitive treatment of paediatric femoral diaphyseal fractures remains controversial. Modalities of treatment vary mostly according to age, with fracture pattern and site having a lesser impact. Current evidence is reflective of this variation with most evidence cited by the American Academy of Orthopedic Surgeons being level 4 or 5. The authors present a review of the most up-to-date evidence relating to the treatment of these fractures in each age group. In an attempt to clarify the current trends, we have produced an algorithm for decision-making based on the experience from our own tertiary referral level 1 major trauma centre.

BackgroundWe present a pilot series of patients with distal forearm fractures manipulated following a proximal periosteal nerve block with local anaesthesia.This is a novel technique which can be utilised in adults and children and is described herein.MethodsWith a median of 40 years (range 10–81 years), 42 patients (16 children) with distal radial and ulnar fractures were included. Of these patients, 40 underwent periosteal blocks in the emergency room or fracture clinic; 2 were already inpatients. Fractures were manipulated routinely and immobilised with plaster. Mobile fluoroscopy was not used for patients in the emergency department or fracture clinic.ResultsOf the 42 patients, 40 patients (95 %) had successful fracture manipulation and did not require subsequent treatment. Two patients (5 %) needed subsequent surgery, one for K-wire stabilisation of their fracture and the second for volar plate fixation. The procedure was described as painless in 35 (83 %) patients (visual analogue scale/VAS score 0), with 6 (14 %) suffering minimal pain (VAS 1–3). In the 12–16-year age group, 15 patients (94 %) described the manipulation as painless; 1 patient described the procedure as minimally painful. No additional analgesia of any kind was given. There were no direct complications from any of the periosteal nerve blocks.ConclusionsLocal anaesthetic periosteal nerve blocks injected proximally to the fracture sites are a simple and yet very effective new technique which provide good/excellent analgesia and facilitate the reduction of distal radial and ulnar fractures.

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