Objectives: The purpose of this study was to compare the outcomes of children whose fractures were manipulated with nitrous oxide with those fractures manipulated under a general anesthetic.

Design: We undertook a retrospective analysis of all children who presented to the emergency department with an angulated or displaced nonphyseal forearm fracture requiring manipulation over a 6-month period.

Patients/participants: Twenty-eight forearm fractures were manipulated using conscious sedation, whereas 27 were manipulated in the operating theatre under general anesthesia.

Main outcome measurements: The quality of reduction, the Cast Index, Padding Index, and Canterbury Index were similar between the 2 groups.

Results: There was a significant difference between the need for remanipulation in the nitrous oxide group (9) compared with the need for remanipulation in the theatre group (3).

Conclusions: Despite a higher failure, manipulation of fractures in the emergency department using conscious sedation can achieve an adequate reduction and a high quality of cast. Failures were due to inherently more unstable fracture personalities.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.