Royal College of Emergency Medicine



PROTOCOL FOR MANAGEMENT OF “COLLES” FRACTURES IN THE EMERGENY DEPARTMENT BY EMERGENCY NURSE PRACTITIONERSThe Emergency Nurse Practitioners have undergone training for the management of patients requiring distal radial fracture manipulation fulfilling the following criteria:Aged 65 and overClosed & Isolated injury (unless able to clear other injuries within the ENP remit)Dorsally angulated distal radial fracture within 2.5 cm proximal to the distal radio-ulnar jointIntra-articular fractures can be manipulated provided either senior emergency medical or orthopaedic opinion in agreementDoes not apply to open fractures / volar angulation / neurovascular compromise/ no skin compromiseThe following steps should be completed for all cases: Appropriate pain relief using the analgesic ladder should be offered from triage □Patients with suspected distal radial fractures should undergo to X-Ray (AP/ Lateral views) imaging for radiological diagnosis after triage □Assessment of neuro-vascular examination of the limb should be undertaken and documented before and after manipulation and POP application □Patient’s consent should be sought for closed MUA in Emergency Department. Ideally this would be written however verbal is accepted when impractical □ Manipulation should be performed with the application of a Haematoma Block using appropriate local anaesthetic □Patients should undergo check X-Rays after manipulation to ensure adequate alignment □ Discharge Planning should include the following: Take home Analgesia / Sling / Discharge advice on POP/ Fracture clinic appointment □ If indicated, keep patient NBM for possible urgent intervention in theatreImmediately discuss with senior if any queries +/– Refer to the orthopaedic (52699/51007) for failures or complicated fracturesMIUH ST Year 6 EM The Mid Yorkshire Hospitals; Muhammad Irfan ul Haq Consultant Anaesthetist, The Aga Khan University Hospital; Richard Gorman Consultant ED, The Mid Yorkshire Hospitals ................
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