Pediatrics
Questions
369.A 6-month-old girl is brought to the ED because of persistent crying
for the past 6 hours. Her teenage father informs you that she has been
inconsolable since awaking from her nap. No recent illness, trauma, fever,
or other complaints are reported. On physical examination the patient is
alert, awake, and crying. You note swelling, deformity, and tenderness of
the left femur. When inquired about this finding, the caretaker responds,
“Her leg got stuck between the rails of her crib.” Radiographs show a mini-
mally displaced spiral fracture of the left femur. Which of the following is
the next best step in management?
a. Genetic workup for osteogenesis imperfecta and other bone abnormalities
b. Orthopedic consultation for closed reduction
c. Serum electrolytes including calcium and phosphate
d. Perform skeletal survey and contact Child Protective Services
e. Placement of posterior splint and discharge home with orthopedic follow-up
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