TABLE 111.1 INDICATIONS FOR EMERGENT ORTHOPEDIC REFERRAL Injuries requiring emergent orthopedic referral Open fractures Concern for compartment syndrome Unacceptably displaced fractures that require reduction Significant growth plate or joint injuries Complete or displaced fractures of the long bones of the lower extremities Pelvic fractures (other than minor avulsions) Spinal fractures Dislocations of major joints other than the shoulder Injuries that can be managed initially by the emergency clinician with outpatient orthopedic follow-up Nondisplaced Salter–Harris type I fractures (exceptions are femur, proximal tibia) Clavicle fractures Nondisplaced upper extremity fractures Routine dislocations of the shoulder and minor joints (finger) with no fracture Nondisplaced fractures of the hand and foot Incomplete, nondisplaced fractures of the long bones of the lower extremities COMPLICATIONS OF FRACTURES: OPEN FRACTURES AND COMPARTMENT SYNDROME Goals of Treatment Rapid identification of a potential open fracture or compartment syndrome is important for urgent orthopedic consultation Open fractures have an increased risk of infection; therefore, early wound management, including tetanus prophylaxis as indicated and prophylactic antibiotics in the ED are vital Compartment syndrome, if not identified and treated, can progress to irreversible muscle and nerve damage Early consultation with orthopedics is necessary for fasciotomy CLINICAL PEARLS AND PITFALLS