Upper limb General Instructions
- Compare injured with uninjured limb.
- Check distal vascular and neurological state.
- Assess tendon function and consider formal exploration of wounds
which may contain partially divided tendon.
- X-ray all wounds caused by glass.
- Compound fractures or joint injuries should all be referred.
- Check anti-tetanus status and treat accordingly.
- After removal of debris, a sterile pad should be applied and
removed only by the Orthopaedic Registrar.
- A digital photo is often helpful.
- Give broad-spectrum antibacterial (anti staphylococcal) cover as soon as the patient has been stabilised.
- Correct alignment and splint major fractures whenever possible and give strong analgesia.
- Establish IV infusion and cross-match for all major fractures of pelvis and lower limbs.
- X-rays are required in at least 2 planes. With injuries to shafts of bones they should include the 2 joints (above and below) e.g. fractured femoral shaft may be accompanied by hip dislocation. In regions with two long bones e.g. forearm and leg, both bones must be demonstrated in their entirety.
- Never underestimate the value of elevation for relief of swelling and pain.
- Beware of spiral fractures in the 0 - 2 age group - non-accidental injury until proven otherwise.
- Beware of pain referred to knee from hip or occasionally the back.
Content by Dr Íomhar O' Sullivan 23/06/2000, Reviewed by Dr ÍOS 02/03/2004, 05/04/2005, 03/07/2006, 31/01/2007. Last review Dr ÍOS 18/08/14.