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> If we were to start pulling younger people's wrists I would insist on a Bier's machine - in the meantime I insist that the orthopods deal with younger patients.

--> I agree that younger bones should be left for orthopods and that's how I do it. I have no specific age for this - if the bone does not look osteoporotic, then I don't call it a "Colles". Decent bone has a good chance of retaining well any position one achieves with it on manipulation and so it is worth getting as close to perfect as possible. Poor bone will very likely fall out of position to some extent or another, so there is likely no major benefit in getting a perfect alignment.
 
The reason I call orthopods for the "young" bones is therefore in order to get them to use a fluoroscopy machine and get a really good position. For this they have to go to theatre. What block they use there is none of my business, but I suspect it will not be Biers... Many years ago, when I worked in an ED abroad, with access to such a fluoroscopy machine and a radiographer in the ED, I did "young" wrists just as happily as osteoporotic ones, using haematoma block or Ketamine...


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