How Soon Should Your Pediatric Fracture Patient Be Seen By The Orthopedic Surgeon?

Bottom Line Recommendations: Fractures (2015) is a 2 page PDF that is worth reviewing every time your pediatric patient comes in with a possible pediatric fracture.The whole document needs to be reviewed and the following is just one section:

MANAGEMENT OF SPECIFIC FRACTURE TYPES
» Please refer to your site’s specific protocols.
» Distal forearm buckle fractures and minor distal fibular fractures (avulsion, non-displaced Salter-Harris I/II) can be treated with a removable device (wrist splint/ankle brace) and self-regulated return to activities.
» A user-friendly pediatric fracture management guideline can be found at http://www.rch.org.au/clinicalguide/fractures/

EMERGENT (<1 HOUR) ORTHOPEDIC CONSULTATION
» Fractures associated with vascular compromise (pulseless/white hand)
» Fractures with signs or symptoms of compartment syndrome

URGENT (<4 HOURS) ORTHOPEDIC CONSULTATION
» Open fracture or impending open fracture (skin tenting)
» Fractures with associated nerve injury
» Fractures associated with vascular compromise (reduced pulse with good perfusion to extremity)
» Fractures associated with deformity
» Growth plate fractures classified as Salter-Harris III, IV, V

NON-URGENT OUTPATIENT ORTHOPEDIC CONSULTATION
» Closed, stable, uncomplicated fractures without deformity (except those detailed below which are appropriate
for primary care physician follow up).
MINOR FRACTURES THAT CAN BE FOLLOWED BY THE PRIMARY CARE PHYSICIAN
» Distal radius buckle (with or without associated ulnar buckle/styloid) fractures
» Minor non-displaced distal fibular fractures: Salter-Harris I, Salter-Harris II, avulsion fractures
» Uncomplicated mid-shaft clavicle fractures

DISCHARGE INSTRUCTIONS

» Ibuprofen (10 mg/kg, max. 600 mg) every 6-8 hours as needed is as effective as morphine in children with
non-operative upper extremity fractures. Ibuprofen is also more effective than acetaminophen with codeine in children with
extremity fractures.
» Provide information on management of injury that includes home care of immobilization device, anticipatory
guidance on recovery and participation in sports, scheduled follow up with a physician.
» Provide information on reasons to return to the emergency department prior to scheduled physician visit – e.g.
increased pain, swelling, fever, cold fingers/toes, cast too tight or other concerns.

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