ED Pathway for Evaluation/Treatment of Child
with a Suspected Extremity Fracture

Child with Suspected Extremity Fracture
Triage Care
Ibuprofen
Splint/sling
Ice pack
Elevation
X-ray protocol
Pain Management
  • Optimize prior to x-ray, splint removal when possible
  • Motrin
  • IN Fentanyl
  • Oxycodone
  • Morphine
  • Analgesia
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Assess:
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Extremity Injury Care
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Immediate Orthopedic
Consultation
Urgent Orthopedic
Consultation
ED Care
  • Open fracture
  • Neurovascular emergency
  • Dislocation hip, knee
  • Proximal Tibial Fracture w/posterior Displacement
  • Amputation
  • Displaced fracture
  • Shoulder, elbow dislocation
  • Partial amputation
  • Nail bed
  • All elbow fractures
  • Displaced clavicle fracture > 12 yrs
  • Non-displaced fracture
  • Clavicle fracture
  • Sprain/strain
  • Nursemaid’s elbow
  • Patellar dislocation
Orthopedic resident works with Team 2 ED Attending
Admit
Other Considerations
Discharge
Pain
Immobilization
   Crutches/walkers
Follow-up
Posted: December 2013
Authors: Barb Pawel, MD; Jim Callahan, MD; Keith Baldwin, MD; Joanne Wood, MD; Phil Scribano, MD;
N. Koepke, CRNP; M. Reno, RN; A. Vinograd, MD; C. Gensemer, ED Orthopedic Tech