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Department of Pediatrics : Academic Divisions : Emergency Medicine : Resident Manual : Orthopedic Emergencies

The following is a list of emergency orthopedic problems that may present acutely to the Pediatric Emergency Department. Some should be seen by the orthopedic service at initial presentation, while others can be appropriately splinted and referred to the Pediatric Orthopedic Clinic for follow up. The clinic number is (843) 876-0444. We are encouraged to fill out an ASAP form and fax it to the number listed at the top of the form to facilitate our Orthopedic patients obtaining rapid, close follow-up. The forms are located in the drawer next to the medical receptionist.

NOTE: Compartment syndrome, open fractures and fractures or dislocations with neurovascular compromise require immediate orthopedic consultation. Keep any patient who may need sedation or anesthesia NPO!

 Urgent Orthopedic ConsultOrtho clinic follow-up
Finger fracturesDisplacedNondisplaced
 AngulatedWell-aligned
 AvulsionsTuft fractures
 Dislocations on case by case basisBoxer's fractures
Forearm fracturesEpiphyseal fracturesNondisplaced type I or II
 --displaced or intraarticularTorus or buckle fractures
 Shaft fractures --displaced 
Elbow injuriesDislocationsNursemaid's elbow (does not need follow-up)
 Fracture dislocations
Displaced medial condyle fractures
Positive posterior fat pad (occult or nondisplaced fractures)
HumerusAll supracondylar fracturesNondisplaced neck fracture
 Displaced shaft fractures 
ShoulderDislocations on a case by case basis  
 AC separationAC sprain
ClavicleComplicated fracturesUncomplicated fractures; often can follow-up with PCP instead
Toes and feetMetatarsal fractures with more than 4mm of displacement or more than 10º of angulation
Multiple fractures
Jones' fracture (proximal metaphysis of the fifth metatarsal)
Aligned fractures
Tuft fractures
Metatarsal fractures
Nondisplaced tarsal fractures
TibiaDisplaced epiphyseal fractures
Shaft fractures (except buckle)
Buckle fractures
AnkleMedial/lateral malleolar fracturesMild-moderate sprain
KneeSevere sprain
Dislocated patella
Tuberosity avulsion
Large effusion
Mild-moderate sprain
PelvisAll fractures exceptavulsion fractures
FemurAll fractures  
SpineAll fractures are referred to neurosurgery  


The following is a list of problems that must be seen by the orthopedist or appropriate subspecialist acutely:

  • All open fractures
  • All nerve lacerations
  • All tendon lacerations
  • Septic joints
  • All postoperative infections
  • Displaced fractures
  • Severe sprains
  • Unreduced dislocations
  • All intraarticular fractures into major joints

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