What now?

It is important to ensure vascular and neurological adequacy. Evidence of poor perfusion or reduced sensation may require prompt transfer to an appropriate hospital setting to enable re-alignment of the injury. However, arterial spasms and altered sensation may occur even if there isn’t ongoing compromise.

A cold, pulseless limb with no or altered sensation is a very unusual situation in a child but can result from significant trauma or from a arterial rupture (in which case swelling at the site of injury may be present).

An open injury, i.e protrusion of bone through the skin, requires operative intervention and there is a increased risk on infection.

Take a note of the surrounding scene. It is important to check the immunisation status of children with open wounds particularly for those that have occurred in a farmyard or other settings where there is a risk of contaminated soil.

Would you have managed this case any differently up until now?