Open #/JOINT Management

ENSURE NO OTHER INJURIES ARE OVERLOOKED

IS THE INJURY ASSOCIATED WITH ANY OF THE FOLLOWING:

• • • Significant crushing of muscle?

    • Poor Peripheral perfusion?

    • Complete Amputation?

    • Neurovascular Compromise?

IF YES TO ANY ABOVE DISCUSS WITH SENIOR IMMEDIATELY.

IS THE OPEN # OR JOINT PROXIMAL TO OR INVOLVING THE DISTAL INTERPHALANGEAL JOINT? IF YES:

• • • Remove jewellery

    • Give pain relief and infiltrate wound block

    • Wash wound and dress with non adherent layer and moist gauze

    • Immobilize fracture and elevate limb in sling

    • IV access and IV antibiotic as per guidelines

    • Check tetanus status and give booster

    • Instruct NBM. Ask time of last meal and drink.

    • Discuss with senior for handover and instructions

    • Admit to ward

IS THE OPEN # DISTAL TO THE DISTAL PHALANX? IF YES:

• • • Remove jewellery

    • Give pain relief and infiltrate ring block

    • Wash wound and dress with non adherent layer, gauze and finger dressing

    • If distal phalanx fracture involving >1/3 of bone immobilize in cap splint and elevate limb in sling

    • Prescribe oral antibiotics as per guidelines

    • Check tetanus status and give booster

    • If associated with vascular compromise of distal pulp discuss with senior

    • Can be discharged home and added to patient list for review and booking for theatre