Figure 18.1

Radiographs of a closed radius and ulna shaft fracture in skeletally immature patient

What to Ask

1. 1.
   
   
   

   
   

   What is the neurovascular status?
   
   
    
   
   
2. 2.
   
   
   

   
   

   Are there any open wounds (possible open fracture)?
   
   
    
   
   
3. 3.
   
   
   

   
   

   Does the patient have pain out of proportion (should raise concern for compartment syndrome)?
   
   
    
   
   
4. 4.
   
   
   

   
   

   Does the patient have IV access on the contralateral arm?
   
   
    
   
   
5. 5.
   
   
   

   
   

   If a reduction is required, has the patient been NPO for an adequate time?
   
   
    

What to Request

1. 1.
   
   
   

   
   

   Radiographs of the wrist, forearm, and elbow must be obtained prior to reduction.
   
   
    
   
   
2. 2.
   
   
   

   
   

   Conscious sedation should be performed by the emergency room to facilitate closed reduction and casting.
   
   
    

When to Escalate

1. 1.
   
   
   

   
   

   Open fractures should be irrigated and receive antibiotics (formal irrigation and debridement in OR).
   
   
    
   
   
2. 2.
   
   
   

   
   

   Concern for compartment syndrome.
   
   
    

Imaging

1. 1.
   
   
   

   
   

   Radiographs of the wrist (AP, lateral, and oblique), forearm (AP, lateral), and elbow (AP, lateral, and oblique)

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