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
Shoulder
| Injury | ED Treatment | Discharge Pathway | |
|---|---|---|---|
| Clavicle | Adult – Undisplaced | Polysling/BAS | VFC |
| Adult – Displaced | Polysling/BAS | VFC | |
| Paediatric – Undisplaced | Polysling/BAS | Discharge sling for 2 weeks then Mobilise as pain allows Advice Sheet: HERE |
|
| Paediatric – Displaced | Polysling/BAS | Discharge | |
| Open #/threatened skin/Floating shoulder | Polysling/BAS | Ortho On Call | |
| Proximal Humerus # | Paediatric – Undisplaced/minimal displacement/angulation | Collar & Cuff | Discharge C&C for 2 weeks, mobilise as pain allows |
| Paediatric – Significant Displacement /angulation | Collar & Cuff | VFC | |
| Adult | Collar & Cuff | VFC | |
| Shoulder Dislocation-NO #! | First time & Recurrent | Reduce ED + Polysling | MSK shoulder Physio Clinic |
| Unreducible | Ortho On-Call | ||
| Fracture Dislocation | Greater Tuberosity # | ED Reduction- Polysling | VFC |
| Unreducible / Multi-fragmentary | Polysling for comfort | Ortho On-Call | |
| ACJ Dislocation | All Grades | Polysling /BAS | MSK shoulder Physio Clinic |
| Open Injury / Threatened skin | Polysling /BAS | Ortho On-Call | |
| Rotator Cuff Injury | Polysling/ BAS | MSK shoulder Physio Clinic | |
| Humeral Shaft (documentation of Radial Nerve function pre/post application of brace) | No Nerve Injury | Humeral Brace with Check XR | VFC |
| Radial Nerve Injury | Humeral Brace with Check XR | Ortho On-Call | |
Elbow
| Injury | ED Treatment | Discharge Pathway | |
|---|---|---|---|
| Elbow dislocation | Reduce ED, Above Elbow Backslab | VFC | |
| Supracondylar # Distal Humerus (Paediatric) | Undisplaced | Above Elbow Backslab (>90 Degrees Flexion) Check XR in cast | VFC |
| Displaced | Above Elbow Backslab (Comfortable position) | Ortho On Call | |
| Paediatric Epi/condylar # | Undisplaced | Above Elbow Backslab | VFC |
| Displaced | Above Elbow Backslab | Ortho On Call | |
| Radial Head/Neck | Undisplaced / Minimally displaced | Collar & Cuff | Discharge |
| Comminuted/significantly displaced | Collar & Cuff (Above Elbow Backslab if pain ++) | VFC | |
| Paediatric Radial Head Subluxation (with Ulna Plastic deformation) | Above Elbow Backslab | VFC | |
| Olecranon | Undisplaced | Above Elbow Backslab | VFC |
| Displaced | Above Elbow Backslab | Ortho On-Call | |
| Fat Pad +ve Elbow | Collar & Cuff | Discharge – Encourage ROM, discard C&C as comfort allows |
|
Hand/Wrist
| Injury | ED Treatment | Discharge Pathway | |
|---|---|---|---|
| Fingertip | Crush # Terminal Phalanx | ? Mallet splint to protect | Discharge |
| Nailbed | Wound Management | GP Practice Nurse Wound review | |
| Significant Soft Tissue Injury/? terminalisation | Plastics | ||
| Mallet Finger | Ext 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 # | Stable | Neighbour strapping 2/52 +/- Splint | Discharge |
| Concern over stability | Neighbour strapping 2/52 +/- Splint | VFC | |
| Displaced phalangeal # | ED Reduction N/S +/- Volar Slab (check Rotation) | VFC | |
| IP Dislocation | Extensor Mechanism - Intact (post reduction) | ED Reduction & NS | Discharge |
| Extensor Mechanism - Disrupted (post reduction) | ED Reduction & Capner Splint | VFC | |
| Metacarpal Neck # | Neighbour strap | Discharge | |
| Bennett’s/ 1st MC Basal # | Bennett’s Slab (Ensure IPJ Mobile) | VFC | |
| Scaphoid | Fracture Identified | Scaphoid Slab | VFC |
| Query Fracture | Scaphoid Slab/Splint | Face-Face # Clinic 2/52 post injury |
|
| Thumb MCPJ Injury | Stable | Splint | VFC |
| ? Unstable | Backslab | Face-Face # Clinic | |
| Volar Plate Injury (+/- Avulsion #) | Neighbour Strap 2/52 | Discharge Advice Sheet-HERE | |
| Minor Trauma Evidence of OA No # | Symptomatic Treatment ? Splint 2/52 | Discharge | |
| Paediatric Torus # Distal Radius | Futura splint 3-4/52 | Discharge Advice Sheet-HERE | |
| Paediatric Radius /Ulna | Undisplacd | AE backslab | VFC |
| Displaced/Angulated | AE backslab | Ortho On-Call | |
Knee
| Injury | ED Treatment | Discharge Pathway | |
|---|---|---|---|
| No Trauma | Symptomatic Treatment | Discharge | |
| OA | Symptomatic Treatment | Discharge | |
| Atraumatic Acute swollen Knee | Bloods Aspirate(Ortho) | Ortho On Call | |
| Tibial Plateau/ Femoral Condlye # | Immobilise | Ortho On Call | |
| Patella Dislocation | First Time – no OC# | Knee Splint WBAT | MSK Lower Limb Physio Clinic |
| First Time – OC# | Knee Splint | VFC | |
| Recurrent | Knee Splint WBAT | MSK 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
| Injury | ED Treatment | Discharge 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 #s | Treat 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 - Present | Backslab | Ortho On-Call |
| Talar shift/displacement - NONE | Walker Boot WBAT | VFC | |
| Isolated Weber C fibula # (Also Need Assessment for medial injury& syndesmotic injury) | Displaced | Backslab | Ortho On-Call |
| Undisplaced | Walker Boot WBAT | VFC | |
| Bimalleolar/ Trimalleolar | Backslab | Ortho On-Call | |
| Tarsal fractures - Small avulsions without disruption of tarsal alignment | Treat as sprain -Walker boot, analgesia, WBAT | Discharge | |
| If Unsure | Treat as sprain -Walker boot, analgesia, WBAT | VFC | |
| Tarsal or cuneiform # | Walker boot, analgesia, WBAT | VFC | |
| Metatarsal # | Intra-articular/basal # ? Lis Franc | Walker boot, analgesia, WBAT | VFC |
| Definite Lis Franc/ Significant displacement | Backslab | Ortho On-Call | |
| Metatarsal Neck & Shaft #s | Minor Trauma/Minimally displaced/stress # | Walker boot /flat post op shoe WBAT | Discharge Advice Sheet-HERE |
| High Energy/ Multiple / Significant displacement | Backslab | Ortho On-Call | |
| Isolated 5th Metatarsal Base (diagram below) | Zone 1 | Walker boot /flat post op shoe WBAT | Discharge |
| Zone 2/3 | Walker boot | VFC | |
| Lesser Toe Injuries #’s/dislocations | ED reduction (if needed) Neighbour Strap WBAT flat shoe/ Normal footwear | Discharge Advice Sheet-HERE | |
| Achilles Tendon Rupture | Equinous Slab, NWB, VTE prophylaxis | Face-Face # Clinic | |
| Talus Neck/Body # | Backslab | Ortho On-Call | |
| Calcaneal # | Walker boot NWB | Ortho On-Call | |
| Tongue Type # | Equinous Slab NWB (Keep NBM) | Ortho On-Call | |
5th MT zones
