Emergency Department Clinical Pathway for the Evaluation/Treatment
of Children with Suspected Long Bone Open Fracture

Transfer from Outside Hospital
Recommend IV antibiotics be given as able
Triage Care
  • Assess neurovascular status, pain
  • Ibuprofen, ice
  • Consider NPO
  • RN Standing Order X-ray as able
Pain Management
Open Fracture Classification Typing
Orthopedics to determine Fracture Type
  • ED Care
    • Sedation
    • Neurovascular assessment
    • Irrigation
    • Reduction (if needed)
    • Splint application
  • Ortho consults with Plastic Surgery
  • Orthopaedic or Trauma Attending
    to Consult:
    • Lower Extremity — Vascular LE Trauma
    • Upper Extremity — Hand Service
To OR with Orthopaedics
Admit to Orthopaedic Service
Consider Admission to Trauma Service if other injuries present
Schedule OR
Posted: April 2018
Revised: October 2022
Authors: K. Baldwin, MD; M. Wood RN; J. Lavelle MD; J. Callahan MD; T. Metjian, PharmD; V. Ho Fung, MD; E. Szydlowski, MD; S. Swami, MD; D. Perks, CRNP; R. Robinson CRNP