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Minor injuries in the Covid-19 pandemic era

As of 1st April, all MIU activity at RCH ED has been redirected to CRCH, open 8am to 10pm. 

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  • Helston minor injury unit has closed to allow the hospital to be used as a frailty step down unit. The MIU staff from here are now supporting other units across the county.

  • Launceston MIU will be closing later this month to allow the staff to support other MIUs.

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Previous guidance of non-operative fractures and base of 5th metatarsal fractures under 'normal' (non-pandemic) circumstances

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NB. All hand fractures must be referred to the 7-day hand fracture clinic which remains operational in Covid-19 era

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Orthopaedic support of community MIUs has switch back from St Michael's hospital, co-opted early in the Covid-19 pandemic but remains hosting an MIU, to RCHT

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BOA guidance 'Management of patients with urgent orthopaedic conditions and trauma during the coronavirus pandemic.'

 

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Key points: Changes in practice in VFC and fracture clinic secondary to COVID 19 preventative measures:

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  1. All patients should avoid coming back to a hospital over the next few months. Q to ask yourself ‘’Does this patient need to come into fracture clinic?’’ Discuss with orthopaedic consultant if unsure.

  2. Use walker boots instead of plastering and consider earlier discharge.

  3. Use soft casts (removable at home) and/or futuro splints where appropriate and avoid further visits where possible

  4. Offer 6 month open appointments as soon as possible.

  5. Proximal Humeral fractures over the age 70 will have a video call follow up from VFC and an open appointment.

  6. Weber A fractures: d/c from VFC : refer to website for use of boot and exercises

  7.  Aim for discharge direct from VFC or trauma unit for all  5TH MT FRACTURES, TOE FRACTURES, UNDISPLACED FRACTURES (NOT TIBIA ETC)

  8. Also for all injuries - give advice on suturing and dressings:Use absorbable sutures where possible to avoid requirement for removal by medical staff. Provide patients with dressing changes and wound advice to minimise re-attendance. 

  9.  Patella dislocations: await further guidance from knee team and see above BOA guideline

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Clinical Guidelines for management of orthopaedics in the ED

http://doclibrary-rcht-intranet.cornwall.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Clinical/EmergencyDepartment/OrthopaedicsInTheEmergencyDepartmentClinicalGuideline.pdf , if not accessible try here (but doclibrary version likely more up to date)

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