Emergency Department Clinical Pathway for Children with a Suspected Extremity Fracture
Child with Suspected Extremity Fracture
Screen for Indicators of Possible NAT
(non-accidental trauma)
(non-accidental trauma)
- Considerations
- Skeletal Survey
- Social Work Consult
- Historical Indicators
- PE Indicators
See ED Suspected Long Bone Open Fracture Pathway if significant associated wound
Assess:
- Neurovascular status
- Immediate pain control
- Additional injuries
- NPO status
- Order radiograph
Extremity Injury Care
Immediate Orthopedic
Consultation
Consultation
Urgent Orthopedic
Consultation
Consultation
ED Care
- Open fracture
- Neurovascular emergency
- Compartment syndrome
- Dislocation hip, knee, SC joint
- Proximal Tibial Fracture w/posterior Displacement
- Amputation
- Displaced Fracture
- Including displaced femur fractures
- 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
All fractures going to the OR or being admitted to an inpatient unit should have a splint placed in the ED
Inpatient
Inpatient admission criteria:
- Open fractures
- Multiple fractures
- Neurovascular compromise
- Transfer from OSH
- Complex medical history
EDECU
EDECU admission criteria:
- Slipped capital femoral epiphysis
- Supracondylar fracture: isolated, displaced, and closed fracture, without neurovascular compromise
Other Considerations
Posted: December 2013
Revised: January 2023
Authors: J. Callahan, MD; K. Baldwin, MD; J. Wood, MD; P. Scribano, MD; N. Koepke, CRNP; M. Reno, RN; A. Vinograd, MD; C. Gensemer, RN; E. Szydlowski, MD; L. McNeely, CRNP; R. Robinson, CRNP; N. Goshtasbi, PA; T. MacDonald, EMT, ROT; T. Lawrence, MD
Revised: January 2023
Authors: J. Callahan, MD; K. Baldwin, MD; J. Wood, MD; P. Scribano, MD; N. Koepke, CRNP; M. Reno, RN; A. Vinograd, MD; C. Gensemer, RN; E. Szydlowski, MD; L. McNeely, CRNP; R. Robinson, CRNP; N. Goshtasbi, PA; T. MacDonald, EMT, ROT; T. Lawrence, MD