Behavior & Development • Mar 07, 2016

Sprained, bruised or broken? When to go to the ER with orthopedic injuries

xrayYour child twists his ankle, falls on a wrist or jams a finger– how can you tell if it is broken? When can orthopedic injuries wait until tomorrow to be seen in the office, and when do you need to get emergency care? I’m a pediatrician that has worked primarily in the ER for more than a decade, and about a quarter of my patients have orthopedic injuries– injuries to their bones or joints. Many of these patient can avoid the ER and be seen in an outpatient orthopedic office, which is generally faster, easier and less expensive.  

Many orthopedic offices have same-day appointments for new injuries, including The Young Athlete Center through St. Louis Children’s Hospital. Here are a few quick guidelines to help you choose the best medical care for your child’s orthopedic injury.  

Seek emergency medical care if:

  • there is numbness or tingling in the injured area or extremity
  • skin feels cold or appears pale or blue, especially in the hands, feet, fingers or toes
  • there is “obvious deformity,” meaning that the bones appear crooked or out of place
  • there is an open wound near a site of possible fracture
  • there is bleeding under a fingernail near a possible broken finger
  • your child’s pain cannot be controlled with a cold pack and standard over-the-counter pain medication
  • your child has multiple injuries, such as after a fall off a bicycle or a car accident
  • your child has a head injury in addition to a possible broken bone or orthopedic injury

Consider taking your child to an outpatient orthopedic clinic if:

  • your child’s pain persists, but none of the above situations exist
  • your child is able to move or use their injured arm, leg, finger or toe, but pain persists. Many children continue to walk on broken legs and ankles and use broken fingers and arms.  Even if your child is moving or using an injured extremity, it may still be broken.  

Consider giving pain control such as an ice pack and acetaminophen and watching your child for a few hours if:

  • your child returns to play within a few minutes
  • there are no bruises or open wounds
  • there is no swelling of the injured area

As always, these are guidelines not rules, and if something about your child’s condition doesn’t seem right or worries you too much, always follow your mom-sense or dad-sense and seek emergency medical care. You can also call your primary care pediatrician’s office for guidance if you are not sure what’s the best approach.  

Trying to decide if you need to go to the ER after a head bump, head bruise or goose egg?  Dr. Kelly Ross can you decide if it’s time to go to the ER or if you can relax at home.  

Does your young athlete have heel pain?  It may be Sever’s disease– Dr. Terra Blatnik can help you find the right treatment.    


  • This is a great guide to injuries in children. Going through several of these cases when I was younger, I was lucky my mother was a nurse. I never believed her when I was little as to why I didn’t need to go to the hospital. Then it was the opposite when I was older. I refused to go sometimes and that lead to the injury becoming worse.