Efficacy of pre-hospital fracture manipulation following ketamine administration: the experience of a single civilian air ambulance trust

Aims Limb fractures are common in pre-hospital care and can be associated with significant haemorrhage and neurovascular compromise. The pre-hospital management of these injuries centres around reduction and splinting. The aim of this study was to quantify the effectiveness of pre-hospital reduction of displaced fractures or dislocations and the incidence of the need for further manipulation in the emergency department. Methods A three-year retrospective database analysis was conducted for all patients sustaining limb injuries who were attended by a single air ambulance and subsequently conveyed to the regional major trauma centre. Only patients who received ketamine, either as an analgesic or sedative, were included. Pre-hospital clinical records and emergency department (ED) notes were examined to determine outcomes. Results Over the study period, 122 patients sustained a limb injury and received ketamine; ED notes were available for 96 (78.7%). Of these, the majority (n=51, 41.8%) received ketamine for analgesia with n=10 (8.2%) receiving it to facilitate manipulation. The principal indication for pre-hospital manipulation was neurovascular compromise (n=7, 70.0%). Of those undergoing manipulation pre-hospital, the majority (n=7, 70.0%) required further manipulation in the ED. Conclusion Pre-hospital manipulation by our regional air ambulance is a relatively low frequency event and in those undergoing a manipulation, a high proportion require further intervention in the ED or operative intervention within the acute phase of care.