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Paediatric Fracture Management in the ED

July 26, 2021


Paediatric fractures are a frequent presentation to SHED, with over 200 patients per month presenting with a fracture.


Alignment to Western Health Best Care Framework

Person-centred Care, Co-ordinated Care, Right Care, Safe Care, Best Care Governance, Quality Systems supporting best care

To review the Western Health Best Care Framework, please visit the live Best Care microsite.

Why is this important?

The Emergency Department can be a daunting place for a child and their family, especially when they are injured and in pain.

Prompt delivery of pain relief, placement of a splint and assessment for imaging, has the potential to vastly improve the experience for the child. Some paediatric fractures (for example supracondylar fractures) have a high risk of neurovascular injury and can be limb threatening.

Timely assessment for this type of injury in the Emergency Department can help to prevent significant long-term morbidity.


What does this look like in practice?

  • Early assessment at triage for pain, deformity and pulse
  • Appropriate triage category and location in ED. Deformity, significant pain or neurovascular compromise would need ready access to a cubicle for assessment and administration of analgesia
  • Intra-nasal fentanyl is a great analgesia for paediatric fractures and is well tolerated and very effective
  • Documenting paediatric weight and allergies directly onto the EMR allows for timely ordering of analgesia
  • Early clinician review for neurovascular assessment, placement of a splint, prescription of analgesia and ordering of imaging when needed



  • Clinical audits
  • Patient feedback


Policies, Procedures and Guidelines

Sunshine Hospital Emergency Department– Children’s Fast Track Clinical Practice Guideline

Virtual Fracture Care (V-FRAC)

Streaming of Patients at Sunshine Emergency Department

Acute Sedation (Adult & Children) – QRG

Children’s Treatment Room – SHED – QRG

Virtual Fracture Clinic (V-FRAC) and Paediatric Virtual Fracture Clinic (P-VFRAC) – QRG


External Links

Clinical Practice Guidelines Acute Pain Management:


Casting videos, including how to place a backslab:


Elbow examination, including neurovascular assessment:


Supracondylar fractures: