Emergent Pediatric Orthopedic Fixation Timing


Original Date: 05/2017 | Supersedes: 05/2017, 09/2021 | Last Review Date: 09/2023
Purpose: The purpose of this guideline is to define the timing of Pediatric Orthopedic specific injuries.


Procedure

Type and severity of acetabular fractures that will be treated versus transferred

All acetabular and pelvic fractures will be treated at our institution.

Timing and sequence for the treatment of long bone fractures in multiply injured patients:

Hemodynamically stable patients

  • definitive fixation/reduction/splinting within 24 hours of clearance by the trauma team

Hemodynamically unstable patients

  • external fixation/reduction/splinting at first OR visit or once cleared by the trauma team
  • temporary splinting for all fractures in the Emergency Department

Open extremity fractures

I&D of fractures with definitive fixation/external fixation/reduction and splinting within 24 hours of admission

Antibiotics will be administered within 60 minutes of arrival to the ED if not already given prior to arrival.  Please refer to the Antibiotic Therapy guideline for further details.

Time to wound coverage

Timing of definitive soft tissue coverage will vary per patient based on complexity of wound and burden of other traumatic injuries but should occur within 7 days (more simple wounds) to 30 days (complex microvascular free flaps) with some clinical exceptions.

Patients with hemodynamically instability secondary to pelvic ring injuries

Please refer to “Management of Hemodynamically Significant Pelvic Fractures” protocol.


References

ACS TQIP Best Practices in the management of orthopaedic trauma. https://www.facs.org/media/mkbnhqtw/ortho_guidelines.pdf (retrieved 07/2023)