Guidelines for ED Management of Orthopedic & Hand Injuries
The Orthopedics and Hand Services remain available to provide input
and guidance for ANY injury. However, conditions appropriate for the
ED to manage and discharge WITHOUT an orthopedics or hand consult are
listed below (if the ED provider is comfortable managing and
discharging).
NO ORTHOPEDICS CONSULT NECESSARY:
Adult Patients
Closed toe fractures
Single metatarsal fractures
Isolated fibular fractures (not tenting)
Non-displaced Distal radius fracture
Proximal humerus fracture (NOTE: an axillary radiograph or limited CT
should ALWAYS be done to demonstrate the shoulder is not dislocated)
Clavicular fracture (not tenting)
AC joint separations
Dislocated shoulder that is relocated
Pediatric Patients
Clavicle fracture
Buckle or nondisplaced fracture of distal radius
Suspected salter 1 or 5 fractures
NO HAND/PLASTICS CONSULT NECESSARY:
Adult Patients
Closed Metacarpal fractures
Closed phalangeal fractures
Reducible finger dislocations
Tendon injury without nerve or vessel injury
non-displaced carpal fractures (EXCEPT scaphoid fracture)
Pediatric Patients
Closed Metacarpal fractures
Closed phalangeal fractures
Reducible finger dislocations
non-displaced carpal fractures (EXCEPT scaphoid fracture)
Simple linear facial lacerations
Splinting recommendations:
Hand & Wrist Fractures
Fractures of distal and middle phalanx: Alumafoam splints should be
used only and should never cross the MP joint (to avoid causing
unnecessary stiffness)
Fractures of small finger: Ulnar gutter splints.
gutter that partially covers the middle finger
An extended ulnar
Thumb fractures: A thumb spica splint is appropriate for any thumb
axis injury from the scaphoid to distal
Index and Middle finger fractures: A dorsal four-finger splint can
be used for index and middle finger as well as multiple finger
injuries.
All splints including fingers should have the MPs flexed at 90
degrees and the IP joints straight.
Toe fracture: hard sole shoe
Single Metatarsal fractures: hard sole shoe
Isolated fibular fractures: ankle posterior splint
Non-displaced distal radius fracture: sugar tong splint
Proximal humerus fracture: sling
Clavicle fracture: sling
Pediatric clavicle: sling