Hand /Wrist VFC

Upper limb cellulitis

A&E management

Assess for systemic and joint sepsis. Take obs (BP, HR, temp etc), take bloods (FBC, U&Es, CRP)

Follow-up

Refer to oncall ortho team for severe cellulitis that require IV antibiotics

Mallet injuries

A&E management

Immobilise in mallet splint. If bony mallet injury - repeat XR in splint (true lateral).

Follow-up

On-line referral to VFC. (refer to oncall to remain subluxed in splint)

Middle phalanx fractures

A&E management

Immoblise stable undisplaced fractures in Bedford splint. For unstable fractures, reduce, apply dorsal zimmer splint, and repeat XR (AP & lateral)

Follow-up

On-line referral to VFC if well aligned. Refer to oncall team if remains displaced after reduction.

PIPJ injuries

A&E management

Follow-up

On-line referral to VFC if reduced.

Proximal phalanx fractures

A&E management

For stable undisplaced fractures, immobilise in Bedford splint. For unstable fractures, reduce and apply buddy-splint and dorsal POSI backslab then repeat XR (lateral and Brewrton views)

Follow-up

On-line referral to VFC if well aligned. Refer to oncall team if remains displaced after reduction.

Metacarpal fractures

A&E management

AP, oblique and True lateral hand x rays (see more for specific treatments)

Follow-up

On-line referral to VFC if no dislocation / subluxation.

Thumb fractures

A&E management

see more for specific treatment

Follow-up

Refer to VFC for phalanx fractures and undisplaced metacarpal fractures

Thumb ligament injuries

A&E management

see more for specific treatment

Follow-up

On-line referral to VFC (discharge those with stable pure ligamentous sprains)

Scaphoid fractures

A&E management

For suspected scaphoid fractures (see scaphoid protocol).
For confirmed scaphoid fractures, apply below elbow cast

Follow-up

For suspected scaphoid fractures (see scaphoid protocol).
For confirmed scaphoid fractures, apply below elbow cast then refer to VFC.