Closed # Management

1. Screen for limb threatening injury

  • Is the injury associated with the following?
      • Significant crushing of muscle
          • Crushed muscle in the palm and forearm can lead to compartment syndrome
  • Poor perfusion distally
      • Check NV status
            • If cap refill is delayed beyond 3 seconds or you cannot assess it then vasculature likely compromised.
            • If distal part is purple and swollen venous return likely compromised.
  • If yes to any of these questions
      • Remove rings
      • Instruct NBM
      • Discuss urgently with senior

2. thorough ASSESSMENT

3. XR the hand: ap, lateral And Oblique

  • Is the fracture significantly displaced?
    • Analgesia
    • MUA
    • Immobilize
    • XR again after attempt.


  • Irreducible fracture
        • Ensure no threat of skin ischemia or necrosis over fracture site
        • Ensure distally perfused
        • If any of the above discuss with senior, else treat as below


  • Not requiring manipulation
        • Remove rings
        • Pain relief
        • Immobilize in POP in Edinburgh position
        • Repeat XR
        • High arm sling
        • Safety net patient (swelling, pain, loss of sensation to fingers or tip ischaemia)
        • Take details and add to trauma list for handover

References

The British Society of Surgery for the Hand. Hand Injury Triage App [Internet]. [cited 2020 Feb 2]. Available from: handinjurytriageapp.bssh.ac.uk
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This subpage has been reviewed by:

1) Mr. Martin Shapev - Plastic Surgery Registrar, RD&E (06/02/2020)