NOTE: This guideline is for use during the COVID-19 outbreak and supersedes previous fracture management guidance for RHC
***If there is any uncertainty over specific fracture definitions or management of the injury then contact RHC orthopaedic registrar.*** For all admissions document COVID status as per symptoms or known contact with symptomatic relative |
Diagnosis |
|
Management |
Follow up |
Parental advice |
Clavicle fracture |
|
Broad arm sling/polysling
|
Nil |
|
AC joint disruption |
|
Broad arm sling |
Physio referral for telephone consultation in 10 days |
|
Shoulder soft tissue injury |
|
Broad arm sling |
Physio referral for telephone consultation in 10-14 days |
Gentle mobilisation as able |
Shoulder dislocation |
|
Reduction in ED or MIU, polysling |
Physio referral for phone consultation in 10-14 days |
Start gentle mobilisation at 10 days. Physio referral to Orthopaedics if any concerns. |
Humeral Fracture |
Proximal |
Collar and cuff |
VFC |
Analgesia, advise to sleep inclined at about 45 degrees |
|
Shaft |
Assess radial nerve; inform ortho if not intact. Humeral brace and collar and cuff or long back slab plus sling. |
VFC |
Analgesia, tight T-shirt may help. Keep sling on. |
Elbows |
|
|
|
|
Elbow dislocation |
|
Reduce and apply backslab and provide collar and cuff; Call for Ortho assistance if not reducible. |
VFC |
|
Elbow Injury
|
Effusion, posterior fat pad; no definite fracture seen |
Collar and cuff |
Nil; |
Mobilisation advice as able. |
Supracondylar Humeral Fracture
|
Gartland 1 |
Collar and cuff (backslab only if necessary for pain relief) |
Nil; |
Analgesia, gentle mobilisation after 3 weeks (may be asked to remove slab at home after 3 weeks) |
Gartland 2 |
Apply backslab at more than 90 degrees of flexion and repeat Xray |
VFC |
Analgesia, may be advised to remove backslab at 3 weeks and mobilise |
|
Gartland 3+ |
Document neurovascular assessment. Call Ortho. |
Post-op follow-up for wire removal at 3 weeks |
Give analgesia before attending for wire removal |
|
Lateral condyle fracture |
Undisplaced |
Backslab |
VFC |
Family may be asked to remove backslab after 5 weeks |
Displaced |
Refer to Orthopaedics for admission and fixation. |
Post-op management via face to face clinic |
|
|
Medial Epicondyle Fracture |
Displaced/undisplaced |
Check Ulnar nerve; if intact, and no associated elbow joint dislocation treat non-operatively in collar and cuff |
VFC |
Likely gentle mobilisation after 2-3 weeks. |
Radial Neck Fracture |
Undisplaced, angulated <25 degrees, not involving joint surface
|
Collar and cuff
|
VFC |
Mobilise as pain allows, discard sling after 14 days |
Angulation, displacement or intra-articular |
Discuss with Orthopaedics
|
Admission or face-to-face Fracture attendance |
As per fracture clinic advice
|
|
Forearm/Wrist Fractures |
Look for Galeazzi/Monteggia patterns |
If present refer to Orthopaedics for admission and fixation |
Follow up as per operative instructions |
|
Forearm shaft
|
No Clinical Deformity
|
Above elbow full cast |
VFC |
|
Clinical deformity
|
Refer Orthopaedics. Consider manipulation under Entonox or Ketamine if appropriate. |
Follow-up via face-to-face fracture clinic as per post manipulation instructions |
|
|
Wrist
|
Buckle fracture
|
Wrist splint 3 weeks
|
No follow-up |
Parents advised to remove splint in 3 weeks (and give leaflet) |
Undisplaced |
Wrist splint 3 weeks
|
No follow-up |
Parents advised to remove splint in 3 weeks |
|
Displaced |
Refer Orthopaedics. Consider manipulation under Entonox or Ketamine if appropriate. |
Follow-up via face-to-face fracture clinic as per post manipulation instructions |
|
|
Wrist: Physeal injury
|
Undisplaced or minimally displaced |
Backslab or removable splint |
No follow-up |
Parents to remove backslab or splint at 4 weeks; no falls for another 3 weeks |
Displaced |
Refer Orthopaedics. Consider manipulation under Entonox or Ketamine if appropriate. |
Follow-up via face-to-face fracture clinic as per post manipulation instructions |
|
|
Scaphoid (Suspected>10 years) |
Clinical |
Wrist splint |
*May be booked onto face-to-face clinic in 9-12 days directly from ED* |
May require repeat imaging |
Diagnosis |
|
Management |
Follow up |
Parental advice |
Hip |
SCFE |
Refer to Orthopaedics for admission and fixation |
As per Consultant operative plan |
|
Femur |
Neck |
Refer Orthopaedics for likely fixation |
As per Consultant operative plan |
|
Shaft
|
Femoral nerve block, Thomas splint; Refer Orthopaedics for admission <7 years hip spica application >7 years fixation |
As per Consultant operative plan |
Family may need spica advice |
|
Distal femur |
Undisplaced: plaster Displaced: Refer Orthopaedics for admission and fixation |
Undisplaced: VFC Displaced: As per Consultant operative plan |
|
|
Knee |
Intra-articular fracture |
Refer Orthopaedics - may need admission for imaging and/or fixation |
As per Consultant operative plan |
|
Small effusion, weight bearing, no fracture |
Soft tissue advice |
Refer directly to Physio
|
Likely telephone physio consultation |
|
Effusion, non weight bearing +/- fracture |
Knee splint |
VFC |
May need face-to-face review and further imaging |
|
Patella dislocation |
Reduce |
Physio referral, no fracture clinic follow-up |
Likely telephone consultation with physio |
Tibia
|
Undisplaced shaft |
Well-fitting long leg cast and supply crutches (may need admission for physio) |
VFC |
Elevate; To return if pain increases |
Displaced shaft +/- fibula fracture
|
Refer Orthopaedics. Consider manipulation under Entonox or Ketamine if appropriate. May require admission for operative management. |
As per post-reduction guidance |
|
|
Toddler fracture (clinical or fracture seen on xray)
|
Walking boot or if none small enough apply backslab. Direct discharge from ED |
Nil |
Family to remove boot at 3 weeks and advise that child may have odd gait/limp for 6 weeks |
|
Isolated fibular shaft fracture
|
|
Symptomatic treatment and walking boot. Direct discharge from ED |
Nil |
Advice re analgesia. Discard boot at 4 weeks |
Ankle
|
Ankle sprain
|
Direct discharge from ED |
Nil |
General soft tissue injury advice re rest, ice, elevation and maintain good ROM |
Distal fibula fracture |
Walking boot and discharge from ED |
Opt in physio at 4 weeks |
Advise to discard boot at 4 weeks and refrain from sport for 6 weeks |
|
Undisplaced distal tibia fracture |
Walking boot and crutches (non or partial weight-bearing) |
VFC |
Likely to be advised to remove boot at home and mobilise as able |
|
Any displaced distal tibia growth plate injury |
Refer Orthopaedics. Consider manipulation under Entonox or Ketamine if appropriate. |
As per post-reduction advice |
|
|
Foot
|
5th metatarsal Jones fracture in adolescent |
Walking boot |
VFC |
|
Base of 5th metatarsal avulsion fracture |
Walking boot |
Nil |
Weight bear as able in walking boot for 2 weeks and then trainer for 2 weeks |
|
Isolated, undisplaced metatarsal shaft fracture |
Walking boot |
Nil if under 10 yrs of age. VFC if > 10 yrs of age. |
Weight bear as able in walking boot for 2 weeks and then trainer for 2 weeks |
|
Multiple displaced metatarsal shaft fractures |
Backslab |
VFC |
|
|
Midfoot |
Lisfranc injury (unstable; swelling+)
|
Refer Orthopaedics. |
As per operative instructions. |
May result in long term stiffness |
Calcaneum
|
Undisplaced |
If undisplaced, walking boot for 4 weeks Assess for other injuries. |
VFC |
|
Displaced |
Refer Orthopaedics : May need admission for further imaging/fixation |
|
Risk of long term pain and stiffness |
|
Great toe
|
No deformity |
Symptomatic treatment |
Nil |
Mobilise as able, may have symptoms for up to 6/52 |
Clinical deformity |
Manipulate with ring block/entonox, elastoplast toe spica +/- moonboot |
Nil |
Remove boot at 3 weeks and mobilise as able |
|
Other toes |
No deformity |
No x-ray needed, buddy strap for comfort |
Nil |
Mobilise as able, may have symptoms for up to 6/52 |
Clinical deformity |
X-ray, reduce as needed and buddy strap |
Nil |
Mobilise as able, may have symptoms for up to 6/52 |
Last reviewed: 27 October 2021
Next review: 31 October 2022
Author(s): Miss Claire Murnaghan, Paediatric Orthopaedic Surgeon