Extremity Fracture Clinical Pathway — Emergency Department

Sternoclavicular Joint Dislocation — Immediate Ortho Consult

  • Usually due to fall onto shoulder or direct blow to clavicle/superior part of sternum
  • Most are anterior and present with anterior prominence next to manubrium
  • Posterior dislocations can cause vasculature damage, tracheal compression or pneumothorax
  • Obtain CT of the chest with IV contrast and 3D reconstruction if concern for SC joint dislocation

Femur Fractures

  • If OR needed for SPICA, send CBC
  • If OR needed for other femur fracture, send CBC, T&S and Blood Type confirmation
  • If a patient has a femur fracture requiring Bucks Traction, this should be done in the ED BEFORE being admitted to inpatient care
    • IV Valium may be required for muscle spasms to assist with placing traction
    • Inpatient bed should be obtained from EVS or EDECU prior to traction
    • If Ortho resident is unavailable, call Inpatient Ortho APP (see Extend pager system for Ortho APP on call)

Clavicle Fracture

  • Urgent Ortho consultation for clavicle fractures with skin tenting/color change
  • All other clavicle fractures do not require Ortho consultation and can be discharged home with a sling with ortho follow up in 1-2 weeks.