Open Long Bone Fracture Clinical Pathway — Emergency Department

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patient Education

Provider Resources

Related Pathways

Child with Suspected Open Long Bone Fracture

Transfer from Outside Hospital

Recommend IV antibiotics and tetanus prophylaxis prior to transfer

ED Triage

ED Team Assessment

Assess Neurovascular Status
- Upper Extremity
- Lower Extremity
- Compartment Syndrome
- Immediate Orthopaedics consult
  for neurovascular concerns
IV Access
Pain Control
Imaging
Antibiotic Recommendations
- Aim to administer within 1 hour of ED arrival

Open Fracture Classification Typing

Ortho to determine Fracture Type

Type I, II, IIIA

Type IIIB

Type IIIC

ED Care
- Sedation
- Neurovascular assessment
- Irrigation
- Reduction (if needed)
- Splint application

Ortho consults with Plastic Surgery

Ortho or Trauma to Consult:
- Lower Extremity — Vascular Surgery
- Upper Extremity — Ortho Hand

To OR with Ortho

Admit to Ortho Service
Consider Admission to Trauma Service if other injuries present

Schedule OR

Posted: April 2018
Last Revised: October 2024

Authors:
- K. Baldwin, MD;
- M. Wood, RN;
- J. Lavelle, MD;
- J. Callahan, MD;
- T. Metjian, PharmD;
- E. Szydlowski, MD;
- S. Swami, MD;
- D. Perks, CRNP;
- R. Robinson, CRNP

Editors: Clinical Pathways Team

Evidence

Pediatric Open Fractures

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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

Evidence

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