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Health Services > Services by Hospital & Facility > Cairns and Hinterland Hospital and Health Service

Fracture Guidelines for Conservative Treatment

A GP Guide

Clavicle Fracture  |  Phalangeal or Metacarpal Fracture |  Buckle Distal Radius Fracture  |  Fracture base of 5th Metatarsal  |  Fractured Neck of 5th Metacarpal  |  Specialist Clinics Home

Clavicle Fracture

 Diagnosis

 Evaluation

 Management

 Referral Guidelines

Undisplaced or Minimally Displaced Clavicle Fracture
  • History/Mechanism
  • Examination
  • X-ray
  • Neurovascular Status of Affected Limb
  • Rest and Ice
  • Analgesia
  • Sling (Immobiliser) for elbow support
  • Patients can come out of sling for Elbow R.O.M and Pendulum Exercises
  • Check X-ray at 4 weeks
  • Out of Sling at 4 weeks, start gentle shoulder ROM
  • Solid union normally achieved at 12 weeks (Adults)
  • >90% of Fractured Clavicles heal without surgery
  • A Fracture at the lateral end is more likely to mal-union
  • Refer if significant shortening or overlap >1.5cm
  • Refer if 'Skin Tenting' is present
  • Refer if an associated scapula fracture is present
  • Refer if non union occurs or does not respond to conservative treatment

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Phalangeal or Metacarpal Fracture

 Diagnosis

 Evaluation

 Management

 Referral Guidelines

Un-displaced or Minimal Phalangeal or Metacarpal Fracture with no Rotational Deformity or Minor Angulation
or
Minimally Dis--placed Salter II (2) Hand Fracture in Children
  • History/Mechanism
  • Examination
  • X-Ray
  • Rest, Ice & Elevation
  • Analgesia
  • Buddy Strap Phalangeal #'s
  • Resting POP Slab for 3 weeks for Metacarpal #'s
  • Sling (Collar & Cuff), only for comfort purposes/elevation
  • X-ray at 3 weeks
  • Then Gentle R.O.M
  • Refer if rotational deformity or delayed union occurs

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Buckle Distal Radius Fracture

 Diagnosis

 Evaluation

 Management

 Referral Guidelines

Buckle Distal Radius Fracture in Children
  • History/Mechanism
  • Examination
  • X-ray
  • Rest, Ice & Elevate
  • Analgesia
  • Splint (POP/Slab) for 4 weeks -  Short Arm Cast
  • Sling for comfort/elevation initially
  • X-ray Out of Plaster at 4 weeks
  • No strenuous activities for 8 weeks from injury
  • Conservative treatment rarely fails

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Fracture base of 5th Metatarsal

 Diagnosis

 Evaluation

 Management

 Referral Guidelines

Un-displaced of Minimally Displaced Fracture base of 5th Metatarsal
  • History/Mechanism
  • Examination
  • X-ray
  • Rest, Ice & Elevation
  • Analgesia
  • Supportive Tubi-grip for 4-6 weeks
  • Check X-ray at 1 week to reassure stability of fracture
  • Can use Crutches initially and patients can Weight Bear as Tolerates
  • Refer if non union occurs or does not respond to conservative treatment

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Fractured Neck of 5th Metacarpal

 Diagnosis

 Evaluation

 Management

 Referral Guidelines

Fractured Neck of 5th Metacarpal with Angulation less than 40 degrees
  • History/Mechanism
  • Examination
  • X-ray
  • Rest, Ice & Elevation
  • Analgesia
  • Sling for comfort/elevation initially
  • Place in Supportive Gutter Slab to immobilise wrist in slight dorsiflexion and MCP joint of little and ring finger at 90 degrees
  • X-ray out of Plaster at 3 weeks
  • Refer if Angulation is greater than 40 degrees
  • Can attempt reduction if confident under local haematoma block
  • Can expect extensor lag at MCPJ for a few weeks after plaster removal

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Last Updated: 26 March 2013
Last Reviewed: 26 March 2013