Specific fracture management in ED

#Clavical - adults: 

• initial treatment: polysling
• management: virtual clinic

#Clavical shaft children:

• initial treatment: polysling
• management: discharge/leaflet

#neck of humerus:

• initial treatment: collar and cuff
• management: virtual clinic (dementia/nursing home - discharge leaflet)

#shaft of humerus:

• initial treatment: velcro brace, collar and cuff
• management: virtual clinic

dislocated shoulder:

• initial treatment: polysling after reduction
• management: virtual clinic

acromio - clavicar jt injury:

• initial treatment: polysling
• management: virtual clinic

dislocated elbow:

• initial treatment: reduce/polysling/backslab depending on discomfort
• management: virtual clinic

supracondylar #humerus (children) undisplaced:

• initial treatment: above elbow POP backslab
• management: virtual clinic

supracondylar #humerus (children) displaced:

• initial treatment: above elbow POP backslab
• management: admit for MUA/wires

#head/neck of radius undisplaced/min displaced + fat pad positive (no fracture seen):

• initial treatment: collar and cuff
• management: discharge / leaflet. Children - virtual clinic

#head/neck of radius - angulated #/comminuted:

• initial treatment: collar and cuff
• management: virtual clinic

#olecranon:

• initial treatment: wool and crepe / polysling
• management: 
  • undisplaced: virtual clinic
  • displaced: admit for ORIF

Scaphoid# or ? scapoid#:

• initial treatment: splint
• management: virtual clinic

Displaced forearm #s, monteggia # dislocation, galeazzi # dislocation:

• initial treatment: above elbow POP backslab
• management: admit for ORIF

Smith's / Barton's #:

• initial treatment: POP backslab
• management: admit for ORIF

Isolated ulna shaft #:

• initial treatment: above elbow POP backslab
• management: admit for ORIF

Colles #: see protocol below

Closed mallet finger (if open refer to hand surgeon on call):

• initial treatment: mallet splint
• management: discharge / leaflet

Displaced/unstable ankle fractures: 

• initial treatment: reduce/backslab and then x-ray
• management: admit for ORIF

# lat malleolus - no talar shift:

• initial treatment: velcro boot
• management: virtual clinic

Isolated # metatarsals/phalanges including # 5MT shaft/base

• initial treatment: velcro boot
• management: discharge/leaflet
• #5MT diametaphysis/Jones # - virtual clinic:

Multiple metatarsals #s / crushed foot:

• initial treatment: padded crepe, analgesia and crutches
• management: admit

Tendo-achilles rupture (squeeze test):

• initial treatment: POP in equinus (if out of hours wool/crepe and plaster room am)
• management: fracture clinic

#pelvis: 

• initial treatment: treat hypovolaemia if required
• major disruption: pelvis splint
• management: admit

# pubic ramus: 

• initial treatment: analgesia
• management: admit - if nursing home resident, discharge if pain allows
• NB: if non-weight bearing with negative x-rays and hip pain admit ortho for MRI

# neck of femur:

• initial treatment: analgesia, IV access and fluids, ECG.
• exclude compounding problems e.g. pneumonia etc.
• management: admit

# femur shaft:

• initial treatment: treat hypovolaemia, x match, nerve block IV analgesia, Thomas splint before x-ray
• management: admit

# patella:

• initial treatment: Camp splint
• management: admit

intercondylar tibial avulsion #:

• initial treatment: Camp splint
• management: admit

# tibial condyle - undisplaced:

• initial treatment: Camp splint (only aspirate haemarthrosis if tense)
• management: virtual clinic

# tibial condyle - displaced:

• initial treatment: Camp splint
• management: admit

# tibial shaft - closed, undisplaced:

• initial treatment: above knee POP backslab
• management: admit (for elevation +/- fixation)

# tibial shaft - displaced, pilon # (intra-articular distal tibia):

• initial treatment: above knee POP backslab
• management: admit

Soft tissue knee injury (haemarthrosis, no fracture) e.g. ligamentous injuries, patellar dislocation, meniscal injuries:

• initial treatment: Camp splint
• management: knee clinic if aged below 40. Otherwise virtual clinic (refer ortho if history suggests tibio-femoral dislocation).

Locked knee (unable to fully extend):

• initial treatment: bandage/crutches/NWB
• management: discuss with ortho reg

Children with undisplaced / minimally displaced greenstick #s:

• initial treatment: POP slab / softcast
• management: virtual clinic

Children "torus buckle" #s:

• initial treatment: splint
• management: discharge / leaflet

Children (under 13 years), displaced #s requiring manipulation:

• initial treatment: POP slab
• management: refer ortho, admit paediatrics.

Adult undisplaced / minimally displaced #s:

• initial treatment: splint
• management: virtual clinic

No functional demand e.g. dementia, paralysed limb patients (stroke):

• initial treatment: POP slab
• Bier's block or refer ortho

High energy injury, open#, neurological deficit, # off ended, grossly unstable # of distal radius and ulna:

• initial treatment: POP slab
• admit for ORIF

# base / shaft 1st metacarpal:

• initial treatment: Futura splint and thumb extension
• management: virtual clinic, hand

Bennett's # (intra-articular Base 1st MC):

• initial treatment: Futura splint and thumb extension
• management: virtual clinic, hand

# 5th metacarpal neck undisplaced:

• initial treatment: buddy strap
• management: discharge / leaflet

# 5th metacarpal neck displaced:

• initial treatment: Volar splint and strap
• management: virtual clinic, hand

# metacarpal shaft / base undisplaced:

• initial treatment: Volar splint and strap
• management: discharge / leaflet

# metacarpal shaft / base displaced:

• initial treatment: Volar splint and strap
• management: virtual clinic, hand

Undisplaced prox / middle phalangeal #s:

• initial treatment: buddy strap
• management: virtual clinic, hand

Displaced  / rotated proximal / middle phalangeal #s:

• initial treatment: Volar splint and strap
• management: virtual clinic, hand

Dislocated IP joints:

• initial treatment: reduce, buddy strap
• management: virtual clinic, hand