Emergency Department Clinical Pathway for Children with a Suspected Extremity Fracture
Possible Non-Accidental Trauma
Child with Suspected Extremity Fracture
ED Team Assessment
- History and Physical
- Neurovascular Status
- Immediate Pain Control
- Assess for additional injuries
- NPO status
- Imaging Recommendations
Significant associated wound
Casting and Splinting Resources
- Immobilization Devices/Cast Types by Injury
- CHOP ACT Cast Trained Responsibilities
- Assess neurovascular status after immobilization placement
Extremity Injury Care
Immediate Orthopedic Consultation
Urgent Orthopedic Consultation
ED Care
- Open Long Bone Fracture
- Neurovascular Emergency
- Compartment syndrome
- Dislocation hip, knee, SC Joint
- Proximal tibial fracture with
posterior displacement - Amputation
- Displaced fracture
- Any fracture with skin tenting
- All Femur Fractures
- All elbow fractures
- Elbow dislocation
- Partial amputation
- Nail bed
- 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
- Open fractures
- Multiple fractures
- Neurovascular compromise
- Transfer from OSH
- Complex medical history
EDECU
- Slipped capital femoral epiphysis
- Supracondylar fracture
- Isolated, displaced, and closed without neurovascular compromise