Are there any open wounds?

Are there any associated injuries?

Is there concern for compartment syndrome?

Is there any evidence of physeal involvement?

Is there any concern for non-accidental trauma (abuse)?

Ensure the leg is stabilized and iced immediately.

X-rays of the knee, femur, and hip to evaluate femur.

Trauma series (X-ray chest and pelvis) appropriate if high energy.

Prepare patient/room for conscious sedation.

Open fractures: should be irrigated and stabilized in ED and receive antibiotics (will require formal irrigation and debridement in OR).

Pain out of proportion/paresthesia: compartment syndrome requires emergent fasciotomy in OR.

Vascular compromise: altered pulse exam or ABI<0.8 (or 0.2 less than contralateral) is suggestive of vascular injury.