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

Job Aid: Assessment for Compartment Syndrome Algorithm

Patient Care Manual – Procedure: Compartment Syndrome

Screen for Indicators of Possible NAT
(non-accidental trauma)
  • Considerations
    • Skeletal Survey
    • Social Work Consult
  • Historical Indicators
  • PE Indicators

See ED Suspected Long Bone Open Fracture Pathway if significant associated wound

Assess:
Extremity Injury Care
Immediate Orthopedic
Consultation
Urgent Orthopedic
Consultation
ED Care
  • Displaced Fracture
    • Including displaced femur fractures
      • If OR needed for SPICA, send CBC
      • If OR needed for other femur fracture, send CBC, T&S
  • 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
Inpatient

Inpatient admission criteria:

  • Open fractures
  • Multiple fractures
  • Neurovascular compromise
  • Transfer from OSH
  • Complex medical history
EDECU

EDECU admission criteria:

  • Slipped capital femoral epiphysis
  • Supracondylar fracture: isolated, displaced, and closed fracture, without neurovascular compromise
Other Considerations
Discharge
Pain
Immobilization
   Crutches/walkers
Follow-up
Posted: December 2013
Revised: August 2015, November 2017 (Reviewed), May 2018, May 2019
Authors: B. Pawel, MD; J. Callahan, MD; K. Baldwin, MD; J. Wood, MD; P. Scribano, MD; N. Koepke, CRNP; M. Reno, RN; A. Vinograd, MD; C. Gensemer, RN