#Limb Injury – Trust Treatment and 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
Shoulder
InjuryED TreatmentDischarge Pathway
ClavicleAdult – Undisplaced Polysling/BASVFC
Adult – Displaced Polysling/BASVFC
Paediatric – UndisplacedPolysling/BASDischarge sling for 2 weeks then Mobilise as pain allows
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
Elbow
InjuryED TreatmentDischarge Pathway
Elbow dislocationReduce ED,
Above Elbow Backslab
VFC
Supracondylar #
Distal Humerus (Paediatric)
UndisplacedAbove Elbow Backslab
(>90 Degrees Flexion)
Check XR in cast
VFC
DisplacedAbove Elbow Backslab
(Comfortable position)
Ortho On Call
Paediatric Epi/condylar #UndisplacedAbove Elbow Backslab VFC
Displaced
Above Elbow Backslab Ortho On Call
Radial Head/Neck Undisplaced / Minimally displacedCollar & CuffDischarge
Comminuted/significantly displacedCollar & Cuff
(Above Elbow Backslab if pain ++)
VFC
Paediatric Radial
Head Subluxation
(with Ulna Plastic deformation)
Above Elbow Backslab VFC
OlecranonUndisplacedAbove Elbow Backslab
VFC
DisplacedAbove Elbow Backslab Ortho On-Call
Fat Pad +ve ElbowCollar & CuffDischarge – Encourage ROM,
discard C&C as comfort allows
Hand/Wrist
InjuryED TreatmentDischarge Pathway
FingertipCrush # Terminal Phalanx? Mallet splint to protect

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

VFC
IP DislocationExtensor Mechanism - Intact
(post reduction)
ED Reduction & NS
Discharge
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
Minor Trauma
Evidence of OA No #
Symptomatic Treatment
? Splint 2/52
Discharge
Paediatric Torus #
Distal Radius
Futura splint 3-4/52Discharge
Paediatric Radius /Ulna UndisplacdAE backslabVFC
Displaced/AngulatedAE backslabOrtho On-Call
Knee
InjuryED TreatmentDischarge Pathway
No TraumaSymptomatic Treatment

Discharge
OASymptomatic Treatment Discharge
Atraumatic Acute
swollen Knee
Bloods
Aspirate(Ortho)
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
Foot/Ankle
InjuryED TreatmentDischarge Pathway
Isolated avulsion # tip
of lateral/medial malleolus
Treat as sprain WBAT, RICE
Ankle Brace/Walker boot if necessary


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

Discharge
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
VFC
Isolated Weber C fibula #
(Also Need Assessment for medial injury& syndesmotic injury)
DisplacedBackslab
Ortho On-Call
UndisplacedWalker Boot WBAT
VFC
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

VFC
Tarsal or cuneiform #Walker boot, analgesia, WBAT
VFC
Metatarsal #Intra-articular/basal # ? Lis FrancWalker boot, analgesia, WBATVFC
Definite Lis Franc/ Significant displacementBackslabOrtho On-Call
Metatarsal
Neck & Shaft #s
Minor Trauma/Minimally displaced/stress #Walker boot /flat post op shoe WBATDischarge
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
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

 

Leave a Reply

Your email address will not be published. Required fields are marked *

five × two =

This site uses Akismet to reduce spam. Learn how your comment data is processed.