Fractures
Diagnosis and Initial Management
MANAGE THE CHILD’S PAIN
- To rate pain and for medication/dosing recommendations, refer to TREKK’s Pain TreatmentBottom Line Recommendations.
- Provide analgesia early and allow adequate time to take effect (depending on route of administration) before imaging or examination. Ibuprofen +/- acetaminophen PO should be offered to any child complaining of pain. Intranasal fentanyl is commonly used for pediatric patients with moderate/severe pain.
- Use a splint to immobilize joints above and below the injury. Elevate injured limb. Apply ice.
ASSESS THE INJURY
- Document child/caregiver’s description(s) of injury mechanism and timing. If high-energy mechanism, assess child for other injuries. Refer to TREKK’s Multisystem Trauma Bottom Line Recommendations.
- For extremity injuries, examine above and below the injury on the same limb, compare with uninjured opposite limb, examine neurovascular status and assess for an open fracture.
ASSESS FOR POTENTIAL INJURY DUE TO MALTREATMENT
- Ensure that the developmental abilities of the child and the reported mechanism align with the fracture location and morphology. If not, discuss with the Child Protection Specialist at Pediatric Referral Centre. A detailed list of factors to consider when assessing for child abuse can be found at TREKK’s Physical Child Abuse Bottom Line Recommendations.
Scroll up to download the full the PDF file for Bottom Line Recommendations: Fractures.