fracture fragment as the reference and another line along the distal fracture fragment The angle measured between the axes of those two lines describes the degree of angulation of the fracture, conventionally reported using the direction of the apex of the fracture (e.g., in Fig 111.5 the femur fracture is medially angulated) FIGURE 111.5 Diagrammatic representation of fracture deformities: displacement (A ), angulation (B ), and overriding with shortening (C ) Indications for orthopedic consultation will vary with the ability and experience of the emergency clinician and availability of the orthopedist Emergent orthopedic consultation is required to evaluate open fractures, those that are significantly displaced, or if neurovascular compromise is present Orthopedic consultation is also recommended during ED visits for pelvic fractures (other than avulsions), spinal injuries, and dislocations of major joints (other than the shoulder) Referral to see an orthopedist as an outpatient within 24 to 48 hours is recommended for any growth plate or intra-articular fractures that have more than to mm of displacement and for fractures of the lower extremity long bones, as long as the extremity is neurovascularly intact and pain is adequately controlled Physeal injuries begin healing quickly; therefore, urgent orthopedic referral is important to ensure adequate reduction of any displaced