Upper Limb TraumaFunctional and radiographic outcomes of Gartland type II supracondylar humerus fractures managed by closed reduction under nitrous oxide as conscious sedationPierantoni, Silviaa; Alberghina, Flaviaa; Cravino, Mattiaa; Paonessa, Matteoa; Canavese, Federicob; Andreacchio, Antonioa Author Information aPediatric Orthopedic Surgery Department, Regina Margherita Children’s Hospital, Torino, Italy bPediatric Surgery Department, University Hospital Estaing, Clermont Ferrand, France Correspondence to Antonio Andreacchio, MD, Regina Margherita Children’s Hospital, Pediatric Orthopedic Surgery Department, Piazza Polonia 94, 10100 Torino, Italy, Tel: +39 011 3131876; fax: +39 011 3135092; e-mail: [email protected] Journal of Pediatric Orthopaedics B: March 2020 - Volume 29 - Issue 2 - p 117-125 doi: 10.1097/BPB.0000000000000679 Buy Metrics Abstract The management of Gartland type II supracondylar fractures remains controversial. This study aimed to evaluate the clinical, functional, and radiographic outcomes of Gartland type II supracondylar fractures treated by immediate closed reduction and casting in the emergency department using equimolar nitrous oxide as conscious sedation. All patients were treated non-operatively using equimolar nitrous oxide as conscious sedation during closed reduction and cast immobilization. Three out of 34 patients (three elbows; 8.8%) were lost during follow-up. The mean follow-up time was 26.4 months (range: 6–48). The mean Quick DASH score at cast removal was 22.4 (range: 19–40) and 2.3 (range: 0–9) at the last follow-up visit in patients without secondary displacement (n = 26; 76.5%). The mean Quick-DASH score of patients (n = 5; 16.1%) requiring closed reduction and percutaneous pinning under general anesthesia because of secondary displacement was 21.4 (range: 19–25) at cast removal and 0.9 (range: 0–2.3) at the last follow-up visit. No significant differences between the two groups were found at any time (P = 0.38 and P = 0.48, respectively). The two groups also showed a comparable radiographic outcome and similar Flynn’s criteria. The mean Numeric Pain Intensity was three (range: 0–6). No complications related to the administration of equimolar nitrous oxide were recorded. The use of equimolar nitrous oxide as conscious sedation for closed reduction and casting appears to be a safe, inexpensive, and appropriate conservative method of treatment for displaced Gartland type II supracondylar fractures in children. A regular follow-up is mandatory to detect early secondary displacement, as 16.1% of fractures required additional closed reduction and percutaneous pinning under general anesthesia. Level IV, retrospective study. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.