Wrist fractures

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

isolated fracture of distal radius

non-displaced

1st line – analgesia + immobilisation + supportive care

Back

1st line –

analgesia + immobilisation + supportive care

Analgesia

Provide appropriate analgesia: fractures are typically associated with moderate to severe pain..

The type and dose of analgesia will vary with the amount of pain the patient is experiencing, the type and severity of injury, and other modifying factors (e.g., age, comorbidities, allergies). In the UK, the National Institute for Health and Care Excellence (NICE) recommends for the immediate management of pain in adults:[31]

Oral paracetamol for mild pain
Oral paracetamol and codeine for moderate pain
Intravenous paracetamol supplemented with intravenous morphine titrated to effect for severe pain.

In frail or older adults, use intravenous opioids with caution and do not offer non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs may be used as supplementary pain relief in other adults, who are not frail or elderly.[31]

In the UK, NICE recommends for the initial management of pain in children (under 16 years) with a suspected radial fracture:[31]

Oral ibuprofen, or oral paracetamol, or both for mild to moderate pain
Intranasal or intravenous opioids for moderate to severe pain (use intravenous opioids if intravenous access has been established).

Initial immobilisation

If the patient is stable, apply a splint to the affected extremity to provide immobilisation and protection. Use either a full cast or a back slab, depending on the expertise of the person applying the splint and the preference of the patient.[17] In children, do not use a rigid cast for torus fractures of the distal radius.[31]

Once the fracture is immobilised, elevate the affected limb using a broad arm sling. Remove any rings as the hand will become swollen. Advise the patient to hold their wrist at the level of the heart when sitting.

Refer the patient to the fracture clinic.

Compartment syndrome

Evaluate the patient for forearm compartment syndrome. Refer the patient with suspected compartment syndrome immediately to orthopaedics.

Compartment syndrome is a surgical emergency and surgery should occur within 1 hour of the decision to operate.[36] See Compartment syndrome of extremities.
If there are obvious signs and symptoms of compartment syndrome, a clinical diagnosis is established and surgical fasciotomy is performed.[51]

Safeguarding

Assess for and document any needs around safeguarding, falls risk, comorbidities, and the nature and classification of the fracture.[31]

Primary options

paracetamol: children: consult specialist for guidance on dose; adults (oral): 500-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day; adults <51 kg body weight (intravenous): 15 mg/kg intravenously every 4-6 hours when required, maximum 60 mg/kg/day; adults ≥51 kg body weight (intravenous): 1000 mg intravenously every 4-6 hours when required, maximum 4000 mg/day (3000 mg/day if risk factors for hepatotoxicity)

-- AND / OR --

ibuprofen: children: consult specialist for guidance on dose; adults: 300-600 mg orally (immediate-release) every 6-8 hours when required, maximum 2400 mg/day

-- AND / OR --

codeine phosphate: adults: 30-60 mg orally every 4 hours when required, maximum 240 mg/day

morphine sulfate: children: consult specialist for guidance on dose; adults: 5-10 mg intravenously every 4 hours initially, adjust dose according to response

diamorphine: children: consult specialist for guidance on intranasal dose

Plus – forearm casting or splint

Back

Plus –

forearm casting or splint

Treatment recommended for ALL patients in selected patient group

Adults

Non-displaced fractures of the distal radius usually result from low-energy injuries and are largely comfortable once the wrist is immobilised.

Definitive treatment is a below-elbow cast for 4 to 6 weeks. A removable wrist splint may also be used.[55]

Consider early mobilisation from a removable support if pain allows.[32][17]

The choice of immobilisation may vary from a cast applied by the surgeon or a cast technician to a custom-made splint from an occupational therapist.

When using a plaster cast the wrist should be positioned at neutral with three-point moulding used to hold the fracture, rather than forced palmar flexion.[32][17]
The thumb is free and the cast terminates at the level of the distal palmar flexion crease. This allows free motion of the metacarpophalangeal joints, thus maintaining digital mobility as the fracture heals, and minimises post-traumatic stiffness.
Casts should be well fitting and well padded to avoid any pressure effects, and the patient must be alerted to the possibility of needing a cast change. Cast changes may be necessary if the cast gets loose as the initial post-traumatic swelling reduces.
Encourage full-finger range of motion exercises while in the cast.

Alternatively, in patients unable to tolerate casts or unwilling to wear a cast, or in patients who have an incomplete fracture of the distal radius, a forearm-based splint holding the wrist at neutral may be used.[56]

Splints are custom-made by occupational therapists, and can be custom-moulded to the patient's anatomy. As swelling reduces, modification to fit the changing dimensions of the patient's limb may be necessary.

Advise patients about the possibility of spontaneous rupture of the extensor pollicis longus (EPL) tendon. This is a rare complication, with an incidence of 5% or less, that tends to occur within the first 12 weeks after injury and is usually preceded by increasing pain over the dorsal aspect of the distal radius.[57] Not all EPL ruptures are symptomatic and not all necessarily need to be treated.

Children

Casting is the definitive treatment for most forearm fractures in children.[33] This is due to the greater capacity for remodelling following fracture union in children compared with adults.[33]

Do not use a rigid cast for torus fractures (also known as buckle fractures) of the distal radius.[33] A soft cast or bandaging may be used instead.[58]

One Cochrane review states that there is reassuring evidence of a full return to previous function with no serious adverse events, including refracture, for correctly diagnosed buckle fractures in children, whatever the treatment used, and that these findings are consistent with the move away from cast immobilisation for these injuries.[59]

Discharge children with a torus fracture after initial assessment; further review is usually not needed.[33]

closed displaced

1st line – analgesia + supportive care

Back

1st line –

analgesia + supportive care

Provide appropriate analgesia: fractures are typically associated with moderate to severe pain.

Oral paracetamol for mild pain
Oral paracetamol and codeine for moderate pain
Intravenous paracetamol supplemented with intravenous morphine titrated to effect for severe pain.

In the UK, NICE recommends for the initial management of pain in children (under 16 years) with a suspected radial fracture:[31]

Oral ibuprofen, or oral paracetamol, or both for mild to moderate pain
Intranasal or intravenous opioids for moderate to severe pain (use intravenous opioids if intravenous access has been established).
- Note that these are often given at the time of the reduction for the sedative and analgesic effects.

Consider regional anaesthesia (haematoma block or peripheral nerve blockade), by healthcare professionals trained in the technique, when reducing a dorsally displaced radial fracture in adults in the emergency department.[31]

Do not give gas and air (nitrous oxide and oxygen) on its own in the emergency department for these fractures.[31]

For a displaced fracture, urgent reduction may be performed in the emergency department by a clinician with the appropriate training and expertise.

For unstable fractures and those requiring fixation, refer the patient immediately to a hand consultant, hand surgeon, or orthopaedic surgeon.

Assess neurovascular function. Refer to a hand or orthopaedic surgeon if compromised.

Explain to the patient what to expect about recovery and returning to normal activities, such as work, education, or driving.[32]

Compartment syndrome

Evaluate the patient for forearm compartment syndrome. Refer the patient with suspected compartment syndrome immediately to orthopaedics.

Compartment syndrome is a surgical emergency and surgery should occur within 1 hour of the decision to operate.[36] See Compartment syndrome of extremities.
If there are obvious signs and symptoms of compartment syndrome, a clinical diagnosis is established and surgical fasciotomy is performed.[51]

Safeguarding

Assess for and document any needs around safeguarding, falls risk, comorbidities, and the nature and classification of the fracture.[31]

Primary options

-- AND / OR --

ibuprofen: children: consult specialist for guidance on dose; adults: 300-600 mg orally (immediate-release) every 6-8 hours when required, maximum 2400 mg/day

-- AND / OR --

codeine phosphate: adults: 30-60 mg orally every 4 hours when required, maximum 240 mg/day

morphine sulfate: children: consult specialist for guidance on dose; adults: 5-10 mg intravenously every 4 hours initially, adjust dose according to response

diamorphine: children: consult specialist for guidance on intranasal dose

Consider – closed reduction and forearm casting

Back

Consider –

closed reduction and forearm casting

Additional treatment recommended for SOME patients in selected patient group

Adults

Definitive treatment of a simple displaced fracture of the distal radius consists of manipulation under anaesthetic and a below-elbow cast for 4 to 6 weeks.

In patients aged 65 years or older, consider non-operative treatment as the primary management for dorsally displaced distal radius fractures, unless there is significant deformity or neurological compromise.[32][17] Consider pre-injury function, medical comorbidities, and fracture characteristics when making a decision.[17]

Reduction may be performed in the emergency department by a clinician with the appropriate training and expertise.

Real-time image guidance may improve manipulations for distal radius fractures performed in the emergency department; however, there is no clear evidence in this area.[31]
Consider the analgesia necessary for this procedure (see analgesia + supportive care above)

Obtain post-reduction radiographs in the splint. Refer patients with displaced fractures that have been well reduced to the fracture/orthopaedic clinic for close follow-up to ensure there is no re-displacement. If reduction is inadequate or unstable, an open reduction and fixation is likely to be necessary (see orthopaedic consultation for surgical fixation below).

More complex fractures may require reproduction of the fracture deformity prior to reduction in order to mobilise the fracture site. Adequate reduction is verified by palpation for step-offs along the dorsal and radial surfaces. The fracture is then held in its reduced position in a well-moulded splint.

The choice between a back slab and a full cast will depend on the expertise of the person applying the splint and the preference of the patient.[17]

When using a plaster cast, the wrist should be positioned at neutral with three-point moulding used to hold the fracture and not forced palmar flexion.[32] Encourage full-finger range of motion exercises while in the cast.

Check the neurovascular status of the limb following reduction and immobilisation. Refer to a hand or orthopaedic surgeon if compromised.

Children

In children, early, definitive manipulation and casting without admission is the standard of care:[33]

Manipulation of a child’s forearm fracture should be performed by competent orthopaedic practitioners.
- Consider the analgesia necessary for this procedure (see analgesia + supportive care above)
Manipulation of a child’s forearm fracture should be followed by orthogonal x-rays.
Assess the neurovascular status of the limb prior to discharge.
Provide oral analgesia to take home, along with information leaflets including information on any red flag symptoms, such as the cast being too tight (causing pain and swelling, which could create a compartment syndrome), or nerve symptoms such as pins and needles or loss of motor function.
A documented review of the case and images by a consultant orthopaedic surgeon should occur within 48 hours of injury.

For a child with a dorsally displaced distal radius fracture who has undergone manipulation, consider a below-elbow plaster cast or K-wire fixation (see orthopaedic consultation for surgical fixation below) if the fracture is completely displaced.[31]

Explain to the patient what to expect about recovery and returning to normal activities, such as education.[32]

Consider – orthopaedic consultation for surgical fixation

Back

Consider –

orthopaedic consultation for surgical fixation

Additional treatment recommended for SOME patients in selected patient group

Adults

If the patient is unsuitable for prolonged casting or you observe inadequate reduction on imaging following manual reduction, consider surgical reduction and fixation.

When surgery is required for a distal radius fracture, the UK National Institute for Health and Care Excellence (NICE) and the British Orthopaedic Association (BOA) recommend that it should be performed:[31][32]

Within 72 hours of the injury for an intra-articular fracture or for a re-displacement
Within 7 days of the injury for an extra-articular fracture.

Surgical fixation may involve closed reduction and casting, closed reduction and K-wire fixation or, if this is not possible, open reduction and internal fixation.[31][32] There is insufficient evidence from randomised controlled trials to determine the role of percutaneous pinning versus cast immobilisation alone.[60] Offer manipulation and cast if satisfactory reduction can be maintained in the plaster. Surgical fixation with K-wires has not been demonstrated to improve patients’ wrist function at 12 months compared with a cast.[61]

Offer K-wire fixation if no fracture of the articular surface of the radial carpal joint is detected, or if displacement of the radial carpal joint can be reduced by closed manipulation.[31]
Volar locking plate fixation was found to result in better fracture alignment than closed reduction and cast immobilisation; however, there were no clinically important differences between treatments with respect to patient-reported pain and function at 12 months post-treatment.[62]

Following volar plate fixation, patients can be safely treated with a soft dressing.[63] Some surgeons prefer a cast for pain management. However, this period should not be longer than 3 weeks.[64] Following K-wire fixation, a gauze is placed over the K-wires and a back slab applied. Wires are generally removed 4 to 6 weeks following surgery.

Children

Consider K-wire fixation or a below-elbow plaster cast (see closed reduction and forearm casting above) if the fracture is completely displaced in a child who has undergone manipulation.[31]

open displaced

1st line – prophylactic antibiotics

Plus – analgesia + immobilisation + supportive care

Back

Plus –

analgesia + immobilisation + supportive care

Treatment recommended for ALL patients in selected patient group

Provide appropriate analgesia: fractures are typically associated with moderate to severe pain.

Oral paracetamol for mild pain
Oral paracetamol and codeine for moderate pain
Intravenous paracetamol supplemented with intravenous morphine titrated to effect for severe pain.

In the UK, NICE recommends for the initial management of pain in children (under 16 years) with a suspected radial fracture:[31]

Oral ibuprofen, or oral paracetamol, or both for mild to moderate pain
Intranasal or intravenous opioids for moderate to severe pain (use intravenous opioids if intravenous access has been established).
- Note that these are often given at the time of the reduction for the sedative and analgesic effects.

Do not give gas and air (nitrous oxide and oxygen) on its own in the emergency department for these fractures.[31]

In the emergency department before referring for debridement:[35][34]

Photograph the open fracture wound when it is first exposed for care
- Keep the photographs in the patient’s records.
- Follow your local protocol regarding taking, handling, and storing photographs and using them for clinical decision making.
Remove gross contamination
Do not irrigate open fractures
- Prior to formal debridement, the wound should be handled only to remove gross contamination and to allow photography. ‘Mini-washouts’ outside the operating theatre environment are not indicated.[34]
Consider using a saline-soaked dressing covered with an occlusive layer.

Provide tetanus toxoid immunisation, if needed.[49]

More information: Tetanus toxoid immunisation

Consider providing a tetanus toxoid immunisation. This may involve a booster dose in a patient who has received an adequate priming course but whose last dose was more than 5 to 10 years ago. A patient who has not received an adequate priming course or is of uncertain immunisation status, or if there is heavy wound contamination, should receive intramuscular tetanus immunoglobulin and a reinforcing dose of vaccine.[49]

Control frank haemorrhage with direct pressure or a tourniquet. Do not use blind clamping of bleeding.[37] Your local protocol should include combined review and decision-making in person by consultant surgeons skilled in vascular repair and skeletal trauma. The ischaemic limb should be revascularised within 4 hours from injury.[37]

Refer to orthopaedic and vascular surgeons if the circulation is compromised.

Realign and splint the limb.[34]

The fracture may be provisionally reduced in the emergency department by a clinician with the appropriate training and expertise.

This helps to reduce deformity and soft-tissue swelling, and may relieve any symptoms of nerve compression.

Consider the analgesia necessary for this procedure.

Repeat and document the neurological and vascular examinations.[37]

Compartment syndrome

Evaluate the patient for forearm compartment syndrome. Refer the patient with suspected compartment syndrome immediately to orthopaedics.

Compartment syndrome is a surgical emergency and surgery should occur within 1 hour of the decision to operate.[36] See Compartment syndrome of extremities.
If there are obvious signs and symptoms of compartment syndrome, a clinical diagnosis is established and surgical fasciotomy is performed.[51]

Safeguarding

Assess for and document any needs around safeguarding, falls risk, comorbidities, and the nature and classification of the fracture.[31]

Primary options

-- AND / OR --

ibuprofen: children: consult specialist for guidance on dose; adults: 300-600 mg orally (immediate-release) every 6-8 hours when required, maximum 2400 mg/day

-- AND / OR --

codeine phosphate: adults: 30-60 mg orally every 4 hours when required, maximum 240 mg/day

morphine sulfate: children: consult specialist for guidance on dose; adults: 5-10 mg intravenously every 4 hours initially, adjust dose according to response

diamorphine: children: consult specialist for guidance on intranasal dose

Plus – surgical debridement + ORIF

Back

Plus –

surgical debridement + ORIF

Treatment recommended for ALL patients in selected patient group

In most situations, open fractures constitute a surgical emergency and operative treatment at the earliest possible opportunity is the preferred method of management. Immediately refer patients with open fractures and/or nerve compromise according to your local protocol. In the UK, this may be to the on-call orthopaedic team.

Refer for debridement, fixation, and soft tissue coverage of an open fracture by consultants in orthopaedic and plastic surgery.[35] Prior to formal debridement, the wound should be handled only to remove gross contamination and to allow photography. ‘Mini-washouts’ outside the operating theatre environment are not indicated.[34]

Debridement should be performed:[35]

Immediately for highly contaminated open fractures
Within 12 hours of the injury for high-energy open fractures that are not highly contaminated
Within 24 hours of the injury for all other open fractures.

Open reduction and internal fixation is performed in the operating theatre. Thorough debridement and irrigation of the fracture and the open wound by the surgical team is required prior to fixation.[50] If the wound is grossly contaminated and there is a high concern for infection, internal fixation may be delayed or external fixation may be utilised as definitive treatment.[50] Use a temporary dressing that avoids wound desiccation and minimises the number of dressing changes after wound excision if immediate definitive soft tissue cover has not been performed.[35]

Most open fractures are high-energy injuries and there is a low threshold to perform concomitant carpal tunnel release if the patient is exhibiting median nerve symptoms. Such injuries may be accompanied by significant soft-tissue trauma. It is not uncommon for these patients to present with very swollen and tense forearms. Monitoring for median nerve function should be maintained throughout the postoperative period.

Open fractures are often obvious, but sometimes an apparently minor surface wound belies severe injury below. Therefore, any fracture associated with an overlying or nearby soft tissue injury, even an apparently innocuous minor wound, needs to be treated as an open fracture until shown otherwise.

isolated scaphoid fracture

1st line – analgesia + supportive care

Back

1st line –

analgesia + supportive care

Analgesia

Provide appropriate analgesia: fractures are typically associated with moderate to severe pain.

Oral paracetamol for mild pain
Oral paracetamol and codeine for moderate pain
Intravenous paracetamol supplemented with intravenous morphine titrated to effect for severe pain.

In the UK, NICE recommends for the initial management of pain in children (under 16 years) with a suspected radial fracture:[31]

Oral ibuprofen, or oral paracetamol, or both for mild to moderate pain
Intranasal or intravenous opioids for moderate to severe pain (use intravenous opioids if intravenous access has been established).

Safeguarding

Assess for and document any needs around safeguarding, falls risk, comorbidities, and the nature and classification of the fracture.[31]

Primary options

-- AND / OR --

ibuprofen: children: consult specialist for guidance on dose; adults: 300-600 mg orally (immediate-release) every 6-8 hours when required, maximum 2400 mg/day

-- AND / OR --

codeine phosphate: adults: 30-60 mg orally every 4 hours when required, maximum 240 mg/day

morphine sulfate: children: consult specialist for guidance on dose; adults: 5-10 mg intravenously every 4 hours initially, adjust dose according to response

diamorphine: children: consult specialist for guidance on intranasal dose

Consider – forearm casting

Consider – surgical reduction and fixation

concomitant distal radius and scaphoid fractures

non-displaced

1st line – analgesia + supportive care

Back

1st line –

analgesia + supportive care

Analgesia

Provide appropriate analgesia: fractures are typically associated with moderate to severe pain.

Oral paracetamol for mild pain
Oral paracetamol and codeine for moderate pain
Intravenous paracetamol supplemented with intravenous morphine titrated to effect for severe pain.

In the UK, NICE recommends for the initial management of pain in children (under 16 years) with a suspected radial fracture:[31]

Oral ibuprofen, or oral paracetamol, or both for mild to moderate pain
Intranasal or intravenous opioids for moderate to severe pain (use intravenous opioids if intravenous access has been established).

Safeguarding

Assess for and document any needs around safeguarding, falls risk, comorbidities, and the nature and classification of the fracture.[31]

Primary options

-- AND / OR --

ibuprofen: children: consult specialist for guidance on dose; adults: 300-600 mg orally (immediate-release) every 6-8 hours when required, maximum 2400 mg/day

-- AND / OR --

codeine phosphate: adults: 30-60 mg orally every 4 hours when required, maximum 240 mg/day

morphine sulfate: children: consult specialist for guidance on dose; adults: 5-10 mg intravenously every 4 hours initially, adjust dose according to response

diamorphine: children: consult specialist for guidance on intranasal dose

Consider – forearm casting

Consider – surgical reduction and fixation

closed displaced

1st line – analgesia + supportive care

Back

1st line –

analgesia + supportive care

Analgesia

Provide appropriate analgesia: fractures are typically associated with moderate to severe pain.

Oral paracetamol for mild pain
Oral paracetamol and codeine for moderate pain
Intravenous paracetamol supplemented with intravenous morphine titrated to effect for severe pain.

In the UK, NICE recommends for the initial management of pain in children (under 16 years) with a suspected radial fracture:[31]

Oral ibuprofen, or oral paracetamol, or both for mild to moderate pain
Intranasal or intravenous opioids for moderate to severe pain (use intravenous opioids if intravenous access has been established).
- These are often given at the time of the reduction for the sedative and analgesic effects.

Safeguarding

Assess for and document any needs around safeguarding, falls risk, comorbidities, and the nature and classification of the fracture.[31]

Primary options

-- AND / OR --

ibuprofen: children: consult specialist for guidance on dose; adults: 300-600 mg orally (immediate-release) every 6-8 hours when required, maximum 2400 mg/day

-- AND / OR --

codeine phosphate: adults: 30-60 mg orally every 4 hours when required, maximum 240 mg/day

morphine sulfate: children: consult specialist for guidance on dose; adults: 5-10 mg intravenously every 4 hours initially, adjust dose according to response

diamorphine: children: consult specialist for guidance on intranasal dose

Plus – surgical reduction and fixation

ONGOING

confirmed wrist fracture

1st line – rehabilitation

Back

1st line –

rehabilitation

Provide the patient or carer with information on managing pain and oedema and recognising the signs and symptoms of common complications.[17][33] Refer patients presenting with excessive pain, oedema, loss of motion, or delayed functional recovery to physiotherapy or occupational therapy.[17]

Appropriate pain management is important, especially during rehabilitation; however, specific treatment varies widely depending on the patient, clinical presentation, method of treatment, and local treatment protocols.

Encourage the patient to use the injured limb while the wrist is immobilised for light functional activities, including self-care and tasks such as typing.[17] This is to help control oedema in the hand and to prevent stiffness in the metacarpophalangeal (MCP) and proximal interphalangeal joints and frozen shoulder.[74][75]

Consider removing the cast (or bandaging in children) and starting mobilisation once pain allows, usually around 4 weeks after the injury in patients with a stable fracture of the distal radius.[32][17]

Consider – osteoporosis assessment

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Wrist fractures

Treatment algorithm

isolated fracture of distal radius

non-displaced

analgesia + immobilisation + supportive care

Analgesia

Initial immobilisation

Compartment syndrome

Safeguarding

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

forearm casting or splint

Adults

Children

closed displaced

analgesia + supportive care

Compartment syndrome

Safeguarding

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

closed reduction and forearm casting

Adults

Children

orthopaedic consultation for surgical fixation

Adults

Children

open displaced

prophylactic antibiotics

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

analgesia + immobilisation + supportive care

More information: Tetanus toxoid immunisation

Compartment syndrome

Safeguarding

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

surgical debridement + ORIF

isolated scaphoid fracture

analgesia + supportive care

Analgesia

Safeguarding

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

forearm casting

surgical reduction and fixation

concomitant distal radius and scaphoid fractures

non-displaced

analgesia + supportive care

Analgesia

Safeguarding

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

forearm casting

surgical reduction and fixation

closed displaced

analgesia + supportive care

Analgesia

Safeguarding

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.