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