Harbor:Fractures (Harbor ED Mgmt)

Background

Per policy, Harbor ED residents and staff are now able to apply splints and initiate follow up with Ortho without involvement of Ortho residents for select injuries. The injuries are shown below. Below each injury is the timeframe for outpatient ED follow up (OK to have ED clerk overbook into ortho fracture clinic, OK per Dr. Hoshino)

Select Injuries with Recommended follow up

• Minimally displaced (<5 mm) midshaft clavicle fracture
  • 2 weeks

• Non-displaced proximal humerus fracture
  • 1 week

• Non-displaced distal radius fractures or non-displaced radial shaft fractures
  • 2 weeks

• Non-displaced, isolated ulnar shaft fracture
  • 2 weeks

• Isolated, non-displaced shaft of humerus fracture
  • 1 week

• Non-displaced radial head fracture
  • 2 weeks

• Minimally displaced (<2 mm) metatarsal/phalanx fracture of the foot, 2/3/4, see Non-fifth metatarsal fracture
  • 2 weeks

• Non-displaced metacarpal shaft and neck fractures see Non-thumb metacarpal fracture (shaft)
  • 3 weeks

• Simple Distal interphalangeal (DIP) dislocation (finger) / Proximal interphalangeal (PIP) dislocation (finger)
  • 1 week

• Distal phalanx (finger) fracture
  • 3 weeks

• Occult scaphoid fracture
  • 3 weeks

• Primary shoulder dislocation
  • 1 week

• Any chronic, non-healing fracture
  • e-consult via DHS PMD or CCC (call ortho pager if you feel needs closer follow up)

Type of orthopedic injury OK for primary ED management	Timeframe for outpatient ED follow up (OK to have ED clerk overbook into ortho fracture clinic, OK per Dr. Hoshino)
Minimally displaced (<5 mm) midshaft clavicle fracture	2 weeks
Non-displaced proximal humerus fracture	1 week
Non-displaced distal radius or radial shaft fracture	2 weeks
Non-displaced, isolated ulnar shaft fracture	2 weeks
Isolated, non-displaced humeral shaft fracture	1 week
Non-displaced radial head fracture	2 weeks
Minimally displaced (<2 mm) metatarsal/phalanx fracture of the foot, 2/3/4	2 weeks
Non-displaced metacarpal shaft and neck fractures	3 weeks
Simple DIP/PIP dislocations	1 week
Distal phalanx fracture	3 weeks
Occult scaphoid fracture	3 weeks
Primary shoulder dislocation	1 week
Any chronic, non-healing fracture	e-consult via DHS PMD or CCC (call ortho pager if you feel needs closer follow up)

Authors

Jonathan Snyder, Ross Donaldson