Pediatric emergency medicine trisk 3425 3425

TABLE 111.1
INDICATIONS FOR EMERGENT ORTHOPEDIC REFERRAL
Injuries requiring emergent orthopedic referral
Open fractures
Concern for compartment syndrome
Unacceptably displaced fractures that require reduction
Significant growth plate or joint injuries
Complete or displaced fractures of the long bones of the lower extremities
Pelvic fractures (other than minor avulsions)
Spinal fractures
Dislocations of major joints other than the shoulder
Injuries that can be managed initially by the emergency clinician with
outpatient orthopedic follow-up
Nondisplaced Salter–Harris type I fractures (exceptions are femur, proximal
tibia)
Clavicle fractures
Nondisplaced upper extremity fractures
Routine dislocations of the shoulder and minor joints (finger) with no fracture
Nondisplaced fractures of the hand and foot
Incomplete, nondisplaced fractures of the long bones of the lower extremities

COMPLICATIONS OF FRACTURES: OPEN FRACTURES AND
COMPARTMENT SYNDROME
Goals of Treatment
Rapid identification of a potential open fracture or compartment syndrome is
important for urgent orthopedic consultation. Open fractures have an increased
risk of infection; therefore, early wound management, including tetanus
prophylaxis as indicated and prophylactic antibiotics in the ED are vital.
Compartment syndrome, if not identified and treated, can progress to irreversible
muscle and nerve damage. Early consultation with orthopedics is necessary for
fasciotomy.

CLINICAL PEARLS AND PITFALLS