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


Cast Types by Injury

Short Arm Cast
  • Buckle Fx
  • Nondisplaced wrist or hand fx
  • Moderate pain with normal xray
Long Arm Cast
  • Both Bone Forearm fx
  • Radius or ulna fx reduced
  • Elbow fx*
  • Monteggia fx
  • Radial head or neck fx
  • Young child**
  • * Elbow fx going to OR is splinted
  • ** Young children can slip out of short arm cast (less muscle mass) so get long arm cast regardless of injury
Short Arm Cast with Thumb Spica
  • *
  • * Some orthopedists will do short arm thumb spica cast with tenderness over scaphoid but normal xray. Ortho will choose.
Long Arm Cast with Thumb Spica
  • Scaphoid fracture
Short Leg Cast
  • Foot fracture (if pain with CAM boot)
  • Ankle fx wtihout reduction
  • SH 1 distal fibulas
Long Leg Cast
  • Distal femur fx non-displaced (metaphyseal and below);
  • Tibia fx* (including Toddlers);
  • Ankle fx requiring reduction

Policy: CAM Boot Use for Lower Extermeity Injuries in the ED

To provide an alternative to splinting or casting in some children and adolescents with injuries of the foot, ankle and distal fibula.