Extremity Fracture Clinical Pathway – Emergency Department – Immobilization Devices/Cast Types by Injury

Extremity Fracture Clinical Pathway – Emergency Department

Immobilization Devices/Cast Types by Injury

These are guidelines for immobilization. Each fracture is different and treatment may be individualized after consultation with orthopedics.

Injury/Indications Immobilization Device Comments
Buckle Fracture Velcro splint
  • Simple buckle fractures that have no cortical break or angulation can be placed in a Velcro splint with PCP follow-up in 4 wks
  • All others should have an ortho consult
  • Greenstick fracture
  • Nondisplaced wrist or hand fracture
 Short arm cast Call ortho for any degree of angulation
  • Both bone forearm fracture
  • Radius or ulna fracture requiring reduction
  • Elbow fracture
  • Monteggia fracture
  • Radial head or neck fracture
  • Young child
 Long arm cast
  • All fractures going to the OR should be splinted in
    the ED
  • Short arm cast may be appropriate in some cases per Ortho recommendations
  • Young children can slip out of short arm cast (less muscle mass) so get long arm cast regardless of injury
Scaphoid fracture or snuffbox tenderness Short arm cast with thumb spica  
  • Foot fracture (if pain with CAM boot)
  • Ankle fracture without reduction
 Short leg cast  
  • Distal femur fracture non-displaced
    (metaphyseal and below);
  • Tibia fracture
  • Ankle fracture requiring reduction
 Long leg cast Short leg splint may be appropriate if concern for ongoing swelling after ankle reduction
Femur fracture in toddlers Spica cast Admit to Ortho for placement
  • Presumed toddler fracture with negative X-ray
  • Nondisplaced fracture
  • Stable, non-displaced foot fractures
  • Foot or ankle injuries or severe sprains with
    negative X-rays
  • Stable, non-displaced fracture of the distal fibula including SH1
  • SH1 or non-displaced buckle fractures of the
    distal tibia
 CAM boot If the X-ray for a toddler's fracture shows any fracture widening, angulation or displacement, call Ortho