Makindo Medical Notes.com

Radial head & neck

Fall on outstretched hand

Posterior interosseous nerve injury: Check

wrist/finger extension

C&C.

Urgent review if displaced. Otherwise discharge with advice

leaflet

Shaft

Fall on outstretched hand or direct blow

Galeazzi – associated dislocation of distal radio- ulnar joint.

May require MUA but depends on degree of angulation and age of pt. If forearm clinically bent – will require MUA.

Above elbow POP

Immediate referral to ortho if requires MUA or Galeazzi

Otherwise Fracture clinic

Distal metaphysis - Colles #

Fall on outstretched hand

Median nerve injury

1. High energy, young pt or complex intra-articular - perform first -aid MUA in ED only if neurovascular compromise or off ended.

2. For frail osteoporotic pts with low demand on wrist MUA in ED as needed, followed by below elbow POP

3. All other pts - MUA in ED. Below elbow full split POP

1. Immediate referral to ortho

2. Fracture clinic

3. Immediate referral to ortho if inadequate position. Otherwise Fracture clinic

Distal metaphysis Smith’s or Barton’s #

Fall on outstretched hand

Median nerve injury

Above elbow POP with wrist dorsiflexed.

Immediate referral to ortho

Styloid

Fall on outstretched hand

none

Simple below elbow POP

Fracture clinic

Buckle/ Torus in 1-16yr olds

Fall on outstretched hand

Missed #

1. Stable Torus i.e. buckle to one cortex, with no deformity, angulation <15^o on XR, not involving the growth plate and within the stable zone (distance from the physis < width of physis) - Splint

2. All other torus #s -Below elbow POP

1. Discharge with Futuro splint for up to 3 weeks and patient info leaflet.

2. Below elbow POP and Fracture clinic. Consider immediate referral if significant deformity

Olecranon

Fall on point of elbow

Open # Displacement by pull of triceps tendon. Ulna nerve injury

1. Hairline crack with minimal displacement – above elbow POP.

2. Displaced - above elbow POP

3. Open – washout, antibiotics and above elbow POP

1. Fracture clinic

2. Immediate referral to ortho

3. Immediate referral to ortho