Emergency Department Clinical Pathway for Supracondylar Humerus Fracture
- Related Pathways
- Transfer Requests from Outside Hospital
- Eligibility for Delayed Outpatient Procedure
- Image Transfer Process
- Assess neurovascular status, pain
- Ibuprofen, ice
- RN Standing Order, 2 view elbow
History and Physical
Assess for other injuries
Skin integrity, neurovascular exam
- Screen for Possible Indicators of NAT
(Non-Accidental Trauma)- Skeletal survey
- Social Work consult
- Historical indicators
- PE indicators
- Disposition based on NAT evaluation
Supracondylar Fracture Classification
Image review by Radiology and Orthopedics to determine fracture classification
Type I Fracture
Type II Fracture
Type III Fracture
- Long arm cast by ED tech
- Orthopedics if no ED tech available
- Ortho APP/resident reviews eligibility for discharge, discusses with Ortho attending
- Cast or splint by Orthopedics
- If casting, no more than 70° flexion
- Splint in 30°–50° flexion by Orthopedics
- Monitor pulses, neurovascular exam
Admit for surgical intervention
Follow-up in 1 wk
- Child to return within 72 hrs for surgery (likely following day add-on)
- Child NPO except clear liquids after midnight until contacted following morning (by noon) with time of surgery
- KOPH Fracture Discharge Scheduling