Emergency Department Clinical Pathway for Children with a Suspected Extremity Fracture

Child with Suspected Extremity Fracture
Screen for Indicators of Possible NAT
(non-accidental trauma)
  • Considerations
    • Skeletal Survey
    • Social Work Consult
  • Historical Indicators
  • PE Indicators
Extremity Injury Care
Immediate Orthopedic
Consultation
Urgent Orthopedic
Consultation
ED Care
  • Non-displaced fracture
  • Clavicle Fracture
  • Sprain/strain
  • Nursemaid’s elbow
  • Patellar dislocation
  • Shoulder dislocation
Admit
All fractures going to the OR or being admitted to an inpatient unit should have a splint placed in the ED
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
Posted: December 2013
Revised: August 2015, November 2017 (Reviewed), May 2018, May 2019, October 2021
Authors: J. Callahan, MD; K. Baldwin, MD; J. Wood, MD; P. Scribano, MD; N. Koepke, CRNP; M. Reno, RN; A. Vinograd, MD; C. Gensemer, RN; E. Szydlowski, MD; L. McNeely, CRNP; R. Robinson, CRNP; N. Goshtasbi, PA; T. MacDonald, EMT, ROT; T. Lawrence, MD