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We do not have a protocol. Orthopedic does our reduction. We touch base with the attending who looks at the fracture and determines disposition. They try everything under fluoroscopy, montaggias, galleazis, distal/proximal. If they can't get it which is rare, then they go to the OR. Usually a higher level resident does the procedure. PEM sedates. 

Ortho determines who goes to the OR

Close reduction for all in the ED even if it's a week out

The only problem we have is with duty hours for the residents. Reductions past 10pm are asked to come in the next day unless critical 

Thank you
Daniel Thimann MD
Jacksonville Fl

> On Jun 26, 2017, at 4:52 PM, Pamela MURPHY <[log in to unmask]> wrote:
> 
> We reduce many forearm fractures (after we insisted that ortho provide instruction).  We usually touch base with ortho and review the case before reduction and to ensure good follow up.  We don't have any protocols but would love to see any if anyone has them.
> 
> 
> Pam
> 
> 
> Pamela S. Murphy, MD, FAAP
> 
> 
> 
> Mendy's Place, Children's Emergency Center
> 
> HonorHealth Deer Valley Medical Center
> 
> 
> 
> Lead Physician
> 
> Myelomeningocele Planning Clinic
> 
> Children's Rehabilitative Services, District Medical Group
> 
> 
> ________________________________
> From: Pediatric Emergency Medicine Discussion List <[log in to unmask]> on behalf of Avva, Usha M.D. <[log in to unmask]>
> Sent: Monday, June 26, 2017 9:49 AM
> To: [log in to unmask]
> Subject: Re: PED-EM-L Digest - 20 Jun 2017 to 23 Jun 2017 (#2017-120)
> 
> In our institution,
> Our Peds ED is covered by both peds and Non peds ortho. The non peds ortho are very comfortable with peds fractures. All open and significantly displaced, or angulated fractures go to the OR. Lot of distal radius and mid forearm fractures are done under Fluro by ortho with the help of procedural sedation from Peds team.  We specifically do not have any protocols. Most of the decision is guided by the availability and comfort of the consultant and the availability of the OR.
> 
> Usha Avva MD
> Interim Division Chief, Pediatric Emergency Medicine
> Dept. of Pediatrics
> Hackensack University Medical center
> Ph: 551-996-5129
> Email: [log in to unmask]
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> 
> 
> -----Original Message-----
> From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of PED-EM-L automatic digest system
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> Subject: PED-EM-L Digest - 20 Jun 2017 to 23 Jun 2017 (#2017-120)
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> There is 1 message totaling 31 lines in this issue.
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> Topics of the day:
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>  1. Question for the group regarding fracture reduction
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
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> ----------------------------------------------------------------------
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> Date:    Fri, 23 Jun 2017 09:12:50 -0400
> From:    Itai Shavit <[log in to unmask]>
> Subject: Question for the group regarding fracture reduction
> 
> Guys, in your ED:
> 
> Are there any clear indications (or a protocol) as to what types of fractures need to be treated surgically (in the OR)?
> 
> Are there any clear indications (or a protocol) as to what types of fractures need to be reduced under fluoroscopy?
> 
> Regarding forearm fractures. Do the orthopedic surgeons in your facility treat with closed reduction all types of fractures? What about Prox. shaft or Mid. shaft Radius? Prox/Mid both bones? Monteggia? What about fractures that occurred 48 hours or more prior ED admission?
> 
> 
> THNX,
> 
> Itai Shavit
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
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> End of PED-EM-L Digest - 20 Jun 2017 to 23 Jun 2017 (#2017-120)
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For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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