Q3.1 When should definitive treatment begin?|
(Person number: Comments)
2: If treatment is ineffective, delay doesn't matter. Is manipulation the right treatment? What is the outcome of interest? Alignment, function, etc?
4: Within extended working day, immediate referral to orthopaedics for assessment/ treatment. Out of extended working hours, mild to moderate displacement, volar slab, sling, analgesic, review orthopaedics 9 am. Significant displacement, immediate orthopaedic involvement.
5: Day of injury or within 48 hours. Research: Early reduction prevents complications.
7: ASAP to keep in line with physiology of bone healing.
8: ASAP. Research: More high volume RCTs. This is an important element in practice.
9: Most delays in surgery for emergencies result in increased morbidity – e.g. in RSD?
11: This depends on extent of displacement and/or soft tissue injury. Optimally fracture reduction best done within 24 hours. Research: Regardless of whether fracture equally reducible later it is better for patient comfort and economically better to do at time of presentation.
17: In practice undertaken ASAP. Don't see any advantage in delaying manipulation.
19: In 24–48 hours, provided no neurovascular damage is present.
23: I believe treatment should be immediate to avoid problems with nerve damage, stiffness etc. Research: Immediate treatment must be proven to be beneficial.
25: At first reasonable opportunity given resource and personnel.
27: Research: previous trial of unknown effectiveness but I'm not sure you would be granted ethics committee approval to conduct similar trial.