FOREARM AND WRIST MANIPULATION IN EMERGENCY DEPARTMENTS: PROGRESS BUT WORK TO BE DONE

Manipulation of fractures in emergency departments is the standard of care in many countries. Multiple techniques have been described, none widely adopted in the UK historically. Nottingham presented their results using intranasal opiate and nitrous oxide in 2014, publishing them in 2016. The GIRFT report, based on data from the years 2016 to 2019, showed that the volume of forearm and wrist manipulations performed on children and young people (CYP) equated to 250 weeks of theatre time annually in England alone. Instituting fracture manipulation in the emergency department was a strong recommendation of the report. To monitor progress towards this goal we devised a metric for the model hospital system that compared the numbers of manipulation is being done between trusts. In order to allow for the different sizes of emergency departments and trusts that number was related to the number of young people seen in emergency departments. Results The median number of manipulations performed in theatre in England has fallen from 28.4 per 10,000 ED attendances by CYP to 11.4 (as of the end of June 2024). The median for the best performing quartile of trusts is 5.8 and the median for the worst 23.7. The figures equate to 100 weeks of operating time in England. Conclusions GIRFT and CRAFFT have made a considerable impact on numbers of manipulations performed in theatre. In the context of lengthy elective waiting lists, colleagues should continue to press for the majority of all manipulations to be done in ED.