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fractures within a safe time period. Referral for outpatient orthopedic follow-up
after initial ED management is recommended for (1) most nondisplaced Salter–
Harris type I fractures, (2) nondisplaced upper extremity, foot, and phalangeal
fractures, (3) incomplete, nondisplaced fractures of the lower extremity long
bones, and (4) reassessment of reduced routine dislocations of the minor joints
and shoulder ( Table 111.1 ).
Disposition
Open fractures, those associated with neurovascular compromise, those at high
risk for the development of compartment syndrome, or fractures requiring
intravenous medication for pain control should be admitted to the hospital for
further orthopedic management. Non-/minimally displaced fractures, wellreduced fractures, as well as successfully reduced dislocations of the minor joints
and shoulder, may be discharged home after immobilization. Discharge
instructions should include guidelines for pain control such as elevation and
ice/cold pack application to the injured extremity and the use of medications at
home, including oral narcotics if necessary. In addition, written instructions
should review signs and symptoms of neurovascular compromise, infection,
compartment syndrome, and other emergent reasons to return to medical
attention.