In a child, identifying a fracture with plain radiographs may be difficult owing to an open epiphysis. It is often necessary to obtain radiographs of the uninvolved hand for comparison. If a surgical procedure is indicated and the child is unable to tolerate the procedure after a digital nerve block alone, conscious sedation may be required. Medications commonly used for conscious sedation include the sedatives/anxiolytics, such as benzodiazepines and barbiturates; pain relief is achieved using opioids such as fentanyl and morphine. In children, a commonly used agent is ketamine, a nonopiate phencyclidine derivative that produces both analgesia and sedation. Before performing conscious sedation, specific attention should be paid to allergies (including those to latex), current medications, and last oral intake of solids and liquids.
Keeping dressings intact on children poses a problem because of their continuous activity, rendering a routine hand dressing and protective finger splint ineffective. If the dressing is deemed essential to wound healing, the child should be placed in a long arm cast. 6 Consultation with the hand or plastic surgeon is recommended for proper follow-up and neurovascular evaluation.
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