General Guidelines for Management of Orthopedic Injuries Always consult orthopedics for (1) open fractures, (2) fracture with neurovascular compromise, (3) anyone admitted with a fracture, or (4) when skin may be compromised (tenting). Always get post-reduction X-rays. Site of Injury Immobilization Follow-up Timing & Location Finger Thumb Phalanx Fractures Thumb Spica Splint Index (2nd digit) Aluminum U shaped (mid/distal phalange) Middle (3rd digit) Radial Gutter (Mid/proximal phalange) • f/u 3-7 days or buddy taping as indicated • Any angular deformity not reducible Ring (4th digit) Aluminum U shaped (mid/distal call Ortho phalange) • Volar Plate injuries- splint x7 days Pinky (5th digit) Ulnar Gutter (Mid/proximal phalange) then buddy tape or buddy taping as indicated • 7-10 days for Tuft Fx and Buckle Fx Reduced proximal interphalangeal Dorsal extension-block splint • Call Ortho for Open Fx dislocation Middle volar plate avulsion Dorsal extension-block splint Phalangeal Mallet (Baseball finger) Mallet Splint Appropriate finger splint vs surgical pin Always Call Ortho Seymour (open phalanx fx w/nail bed injury) Fix/remove nail, suture laceration Need Antibiotics Proximal Pole Scaphoid Fx: Call Ortho Scaphoid or Trapezium Thumb Spica Splint Actual Fx: 3-7d w/Ortho Other Carpal Fx call Ortho Suspected Fx: 10-14d w/Ortho Any angulation, clinical 1st Metacarpal Thumb Spica Splint deformity/displacement – Call Ortho f/u 3-7 day w/Ortho 2nd Metacarpal Acceptable angulation: Neck <20°, Shaft < 10° Radial Gutter Splint 3rd Metacarpal Acceptable angulation: Over angulation limits or any Neck < , Shaft < 30° 10° displacement – Call Ortho th 4 Metacarpal f/u 3-7 day w/Ortho Acceptable angulation: Neck < , Shaft < 40° 20° Ulnar Gutter Splint 5th Metacarpal Acceptable angulation: Neck <50°, Shaft < 30° Forearm Radius & Ulna Shaft Shaft < Acceptable 10° Sugar-Tong Splint Displaced – Reduce then call Ortho with simple sling Distal (Colles & Smiths Fx) Radial shortening > 5mm – Call Ortho Distal Metaphysis < 15° Acceptable Nondisplaced – f/u Ortho 3-7 days Double Sugar-Tong Splint Radius & Ulna – Proximal with simple sling Long- Posterior Splint (elbow 90°) Angulated > 30° Call Ortho Radial Head/Neck with simple sling f/u 5-7 days Elbow Lateral Condyle Acceptable displacement < 1mm Any condyle displacement > 2mm – Call Long-Arm Posterior Splint Medial Condyle Ortho Acceptable displacement <2mm (elbow at 90 ) with simple sling ° 3-7 days w/Ortho Supracondylar Type 1 & Non-Angulated Type 2 Supracondylar Long-Arm Posterior Splint in position of Always Call Ortho for Surgery Angulated Type 2, and All Type 3 comfort with simple sling

Developed by Ryan Meller, MD in collaboration with Aaron Osborne, DO Last Updated: 08/15/2018 Page 1 of 2 Long-Arm Posterior Splint Fracture with skin compromise Olecranon Elbow at < 90° to take tension off (tenting) – Call Ortho with simple sling 3-7 days w/Ortho /Upper Arm Fracture with skin compromise Clavicle Simple Sling (no splinting) (tenting) – Call Ortho 7-10 days w/Ortho After Reduction- Sling with shoulder Shoulder Dislocation 5-7 days w/ Ortho immobilizer Humerus -Proximal Simple Sling Translation > 50% – Call Ortho Ask Rad Tech for Scapular Y view *No Reductions 5-7 days w/Ortho (outpatient surgery) Humerus - Shaft Sugar-Tong Coaptation Splint w/Sling 5-7 days w/Ortho (outpatient surgery) Pelvis Pelvic Binder only if open book Admit & Call Ortho Hip Position of comfort & Good Circulation Admit & Call Ortho Femur Shaft Position of comfort & Good Circulation Admit & Call Ortho Distal Buckle (peds nondisplaced) Long-Leg Splint (No weight bearing) Call Ortho Knee Knee Immobilizer after reduction Patella Dislocation (Weight-bearing as tolerated) Knee Immobilizer. Outpatient surgery (No weight bearing) 3-7 days w/Ortho Knee Immobilizer or Ace Wrap w/ Suspect Ligament/Meniscus injury Crutches (toe down weight-bearing for balance only) Posterior Long-Leg or Knee Spine/Plateau Fracture Always Call Ortho Immobilizer (No weight bearing) Tibia & Likely Admit for urgent surgery Always Call Ortho Tibia Fracture – displaced Long-Leg Posterior Splint +/- Short-Leg Stirrup Splint (No weight bearing) Tibia Fracture – nondisplaced 3-7 days w/Ortho Knee Immobilizer (touch down weight- Proximal Fibula No Call bearing for balance only) Distal Fibula Fracture 3-7 days w/Ortho Short-Leg Posterior Splint Calcaneus Fracture (No weight bearing) Always Call to Ortho Talus Fracture if suspected consider CT scan 3-7 days w/Ortho Any translation or Short-Leg Posterior w/Leg Stirrup displacement s/p reduction call Ortho Splint Tri-planar Fracture (Malleolar) (No weight bearing) Always Call to Ortho Short-Leg Posterior w/Stirrup Splint 3-7 days w/Ortho Tarsal Fractures (except Talus) (No weight bearing) Call Ortho for displaced fx 7-10 days w/Ortho Metatarsal Fx & Jones Fx (Proximal Short-Leg Posterior Splint Angulation >10° or dorsal/planar 5th) (No weight bearing) displacement > 3-4mm – Call Ortho Hard Sole Shoe +/- Buddy Taping 7-10 days w/Ortho Toe Fracture (OK for weight bearing) Seymour fx w/toe nail injury-Call Ortho Foot Dislocation May need open reduction in OR Call Ortho

Developed by Ryan Meller, MD in collaboration with Aaron Osborne, DO Last Updated: 08/15/2018 Page 2 of 2