#Limb Injury – Trust Treatment & Follow-Up

Select the appropriate body area for guidance table

No Spinal injuries, back pain, Cauda Equina, foot drop etc to be referred to VFC

Patients that will not be suitable & need a “face-to-face” as below

  • Homeless patients
  • Prisoners
  • Non English Speaking Patients
  • Inpatients
  • Patients with Hearing Difficulties
  • Phoneless Patients
  • Injuries Associated with Domestic or Child Abuse
  • Children under 2 Years of Age
InjuryED TreatmentDischarge Pathway
ClavicleAdult – Undisplaced Polysling/BASVFC
Adult – Displaced Polysling/BASVFC
Paediatric – UndisplacedPolysling/BASDischarge sling for 2 weeks then Mobilise as pain allows
Advice Sheet: HERE
Paediatric – DisplacedPolysling/BASDischarge
Open #/threatened skin/Floating shoulder
Polysling/BASOrtho On Call
Proximal Humerus #Paediatric – Undisplaced/minimal displacement/angulationCollar & CuffDischarge C&C for 2 weeks, mobilise as pain allows
Paediatric – Significant Displacement /angulationCollar & CuffVFC
AdultCollar & CuffVFC
Shoulder Dislocation-NO #!First time & RecurrentReduce ED + Polysling
MSK shoulder Physio Clinic
Unreducible Ortho On-Call
Fracture Dislocation Greater Tuberosity #ED Reduction- PolyslingVFC
Unreducible / Multi-fragmentaryPolysling for comfort Ortho On-Call
ACJ DislocationAll GradesPolysling /BASMSK shoulder Physio Clinic
Open Injury / Threatened skinPolysling /BASOrtho On-Call
Rotator Cuff InjuryPolysling/ BASMSK shoulder Physio Clinic
Humeral Shaft
(documentation of Radial Nerve function
pre/post application of brace)
No Nerve InjuryHumeral Brace with Check XRVFC
Radial Nerve InjuryHumeral Brace with Check XROrtho On-Call
InjuryED TreatmentDischarge Pathway
Elbow dislocationReduce ED,
Above Elbow Backslab
Supracondylar #
Distal Humerus (Paediatric)
UndisplacedAbove Elbow Backslab
(>90 Degrees Flexion)
Check XR in cast
DisplacedAbove Elbow Backslab
(Comfortable position)
Ortho On Call
Paediatric Epi/condylar #UndisplacedAbove Elbow Backslab VFC
Above Elbow Backslab Ortho On Call
Radial Head/Neck Undisplaced / Minimally displacedCollar & CuffDischarge
Comminuted/significantly displacedCollar & Cuff
(Above Elbow Backslab if pain ++)
Paediatric Radial
Head Subluxation
(with Ulna Plastic deformation)
Above Elbow Backslab VFC
OlecranonUndisplacedAbove Elbow Backslab
DisplacedAbove Elbow Backslab Ortho On-Call
Fat Pad +ve ElbowCollar & CuffDischarge – Encourage ROM,
discard C&C as comfort allows
InjuryED TreatmentDischarge Pathway
FingertipCrush # Terminal Phalanx? Mallet splint to protect

NailbedWound Management
GP Practice Nurse Wound review
Significant Soft Tissue
Injury/? terminalisation
Mallet FingerExt Tendon (No Bony Injury)Well-fitting Mallet splint
(Ensure allows PIPJ Flexion)
8/52 then 4/52 at night
Avulsion # <50%
Joint Surface
6/52 then 4-6/52 night
(XR in splint to ensure joint congruence)
Avulsion # >50%
Joint Surface
6/52 then 4-6/52 night
(XR in splint to ensure joint congruence)
Undisplaced Phalangeal # /
Metacarpal #
StableNeighbour strapping 2/52
+/- Splint
Concern over stabilityNeighbour strapping 2/52
+/- Splint
Displaced phalangeal # ED Reduction
N/S +/- Volar Slab
(check Rotation)

IP DislocationExtensor Mechanism - Intact
(post reduction)
ED Reduction & NS
Extensor Mechanism - Disrupted
(post reduction)
ED Reduction & Capner SplintVFC
Metacarpal Neck #Neighbour strap Discharge
Bennett’s/ 1st MC Basal #Bennett’s Slab (Ensure IPJ Mobile)VFC
ScaphoidFracture IdentifiedScaphoid SlabVFC
Query FractureScaphoid Slab/SplintFace-Face # Clinic
2/52 post injury
Thumb MCPJ Injury StableSplintVFC
? UnstableBackslabFace-Face # Clinic
Volar Plate Injury
(+/- Avulsion #)
Neighbour Strap 2/52Discharge Advice Sheet-HERE
Minor Trauma
Evidence of OA No #
Symptomatic Treatment
? Splint 2/52
Paediatric Torus #
Distal Radius
Futura splint 3-4/52Discharge Advice Sheet-HERE
Paediatric Radius /Ulna UndisplacdAE backslabVFC
Displaced/AngulatedAE backslabOrtho On-Call
InjuryED TreatmentDischarge Pathway
No TraumaSymptomatic Treatment

OASymptomatic Treatment Discharge
Atraumatic Acute
swollen Knee
Ortho On Call
Tibial Plateau/ Femoral Condlye #ImmobiliseOrtho On Call
Patella DislocationFirst Time – no OC#
Knee Splint WBATMSK Lower Limb Physio Clinic
First Time – OC# Knee Splint VFC
Recurrent Knee Splint WBATMSK Lower Limb Physio Clinic
Patella Tendon/ Quads Tendon Rupture
Knee Splint Ortho On Call
?Meniscal, ?Ligament Injury Knee Splint
MSK Lower Limb Physio Clinic
InjuryED TreatmentDischarge Pathway
Isolated avulsion # tip
of lateral/medial malleolus
Treat as sprain WBAT, RICE
Ankle Brace/Walker boot if necessary

Isolated Weber A distal fibula #sTreat as sprain WBAT, RICE
Ankle Brace/Walker boot

Advice to contact VFC if symptoms > 3/12
Isolated Weber B Lateral Malleolar #
(Documentation must include:
Is there medial swelling? Yes/No
Is there medial tenderness? Yes/No
Is there medial bruising? Yes/No)
Talar shift/displacement - PresentBackslabOrtho On-Call
Talar shift/displacement - NONEWalker Boot WBAT
Isolated Weber C fibula #
(Also Need Assessment for medial injury& syndesmotic injury)
Ortho On-Call
UndisplacedWalker Boot WBAT
Bimalleolar/ TrimalleolarBackslab
Ortho On-Call
Tarsal fractures - Small avulsions without
disruption of tarsal alignment
Treat as sprain -Walker boot, analgesia, WBATDischarge
If UnsureTreat as sprain -Walker boot, analgesia, WBAT

Tarsal or cuneiform #Walker boot, analgesia, WBAT
Metatarsal #Intra-articular/basal # ? Lis FrancWalker boot, analgesia, WBATVFC
Definite Lis Franc/ Significant displacementBackslabOrtho On-Call
Neck & Shaft #s
Minor Trauma/Minimally displaced/stress #Walker boot /flat post op shoe WBATDischarge Advice Sheet-HERE
High Energy/ Multiple / Significant displacement
BackslabOrtho On-Call
Isolated 5th Metatarsal Base
(diagram below)
Zone 1Walker boot /flat post op shoe WBATDischarge
Zone 2/3 Walker bootVFC
Lesser Toe Injuries #’s/dislocationsED reduction (if needed)
Neighbour Strap
WBAT flat shoe/ Normal footwear
Discharge Advice Sheet-HERE
Achilles Tendon RuptureEquinous Slab, NWB,
VTE prophylaxis
Face-Face # Clinic
Talus Neck/Body #BackslabOrtho On-Call
Calcaneal #Walker boot NWBOrtho On-Call
Tongue Type #Equinous Slab NWB (Keep NBM) Ortho On-Call

5th MT zones


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