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Triage and immediate threats
High-risk features
Open fracture
Visible bone or deep wound over fracture
Gross contamination
Neurovascular compromise
Pulseless or delayed capillary refill
Progressive paresthesia or weakness
Compartment syndrome concern
Escalating pain out of proportion
Pain with passive finger stretch
Threatened skin
Tenting
Impending volar skin necrosis
Polytrauma or high-energy mechanism
Fall from height
Motor vehicle collision
Immediate actions
If pulseless hand or rapidly worsening neuro exam, immediate reduction attempt (Class I consensus)
Document pre-reduction neurovascular status
Post-reduction pulse and perfusion reassessment
If open fracture, antibiotics and urgent orthopedics (Class I consensus)
Tetanus status update
Sterile dressing and splinting
If severe deformity with skin compromise, urgent reduction and splint (Class I consensus)
Finger trap traction or manual traction technique
Repeat skin check after splinting
Analgesia and sedation planning
Pain control pathway
Oral analgesia for mild pain
IV opioids for severe pain or reduction
Regional anesthesia options for reduction
Hematoma block option
Bier block option for dorsally displaced DRF in adults (NICE NG38)
Sedation safety framework
ED procedural sedation by trained clinicians supported by ACEP policy (ACEP policy statement)
Dedicated monitoring and airway readiness for moderate to deep sedation
Monitoring targets
Perfusion targets
Warm, well-perfused hand
Capillary refill normalizing
Neuro targets
Median nerve symptom improvement or stability
Ulnar and radial nerve stability
Splint safety targets
No circumferential constriction
Swelling accommodation
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.