ED Management of Pediatric Fractures when Discharging Home for ED

 ED Management of Pediatric Orthopaedically Injured Patients with Anticipated Discharge from ED 

 

The purpose of this guideline is to help guide the decision for Orthopaedic Surgery consult, specifically for children who are expected to be discharged with Pediatric Orthopaedic follow-up.  

 

Independent ER Management 

• Non-displaced clavicle fractures 

• Acromioclavicular separation 

• Glenohumeral dislocation – with axillary lateral x-ray  demonstrating anatomic reduction 

• Non-displaced forearm fracture 

• Distal radius buckle fracture 

• Non-displaced metacarpal or phalanx fractures of the hand 

• Soft tissue injury without bone or joint involvement 

• Transient synovitis of the hip – ≤1/ 4 Kocher criteria (per septic hip algorithm) 

• Toddler fracture (non-displaced, spiral tibia fracture) 

• Non-displaced metatarsal or phalanx fractures of the foot 

 

Orthopedic Surgery Consult Recommended 

General rules: 

• Any fracture involving the growth plate 

• Any displaced fracture 

• Any elbow injury 

• Any musculoskeletal infection 

Specific Injuries: 

• Displaced clavicle fractures 

• Proximal humerus fractures 

• Humeral shaft fractures 

• Any elbow injury – normal x-ray w/ effusion, elbow dislocation, medial epicondyle fx, lateral condyle fx, supracondular humerus fx, radial neck fx, olecranon fx 

• Displaced forearm fractures 

• Displaced metacarpal or phalanx fractures of the hand 

• Septic hip – ≥2/4 Kocher criteria (per septic hip algorithm) 

• Proximal femur fractures 

• Femoral shaft fractures 

• Distal femur fractures 

• Intra-articular fractures of the knee – tibial spine fx, proximal tibial epiphyseal fx, tibial tubercle fx 

• Tibia shaft fractures 

• Physeal fractures of the ankle 

• Displaced metatarsal or phalanx fractures of the foot 

 

 

 

 Disclaimer

These guidelines are not intended as a directive or to present a definitive statement of the applicable standard of patient care.  They are offered as an approach for quality assurance and risk management and are subject to (1) revision as warranted by the continuing evaluation of technology and practice; (2) the overall individual professional discretion and judgment of the treating provider in a given patient circumstance; and (3) the patient’s willingness to follow the recommended treatment. 

 

 

 

This list was compiled by representatives of Orthopaedics (peds & trauma) and Emergency Medicine (chairman & pediatric). 

Developed:  ___2014___ Revised:  ___5/2016___ Reviewed by EM & ORF 7/2021 Reviewed 2017, 2020, 2024