Closed # Management
1. Screen for limb threatening injury
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
- Significant crushing of muscle
- 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.
- Check NV status
- If yes to any of these questions
- Remove rings
- Instruct NBM
- Discuss urgently with senior
2. thorough ASSESSMENT
2. thorough ASSESSMENT
3. XR the hand: ap, lateral And Oblique
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
References
The British Society of Surgery for the Hand. Hand Injury Triage App [Internet]. [cited 2020 Feb 2]. Available from: handinjurytriageapp.bssh.ac.uk
Header Image: Licensed with Adobe Stock 2019
Header Image: Licensed with Adobe Stock 2019
This subpage has been reviewed by:
1) Mr. Martin Shapev - Plastic Surgery Registrar, RD&E (06/02/2020)
1) Mr. Martin Shapev - Plastic Surgery Registrar, RD&E (06/02/2020)