Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For the management of soft tissue injuries in adults, several aspects of rehabilitation and monitoring should be considered.
- Swelling and Oedema Management: Discuss with patients the expected swelling after a traumatic injury, how to monitor it daily, and the signs or symptoms that warrant medical advice NICE NG211. Consider alternative medical causes for unexpected swelling, such as deep vein thrombosis, and investigate as necessary NICE NG211. Initiate a programme of circulation exercises and elevate the affected limb to prevent and reduce swelling NICE NG211. Compression bandaging may be considered under specialist supervision, for example, from a hand therapy specialist NICE NG211.
- Scar Management: Encourage patients to desensitise themselves to their injury by looking at, gently touching, and moving the affected area NICE NG211. Reassure patients that unpleasant sensations like pain and itchiness in the area of wounds or skin injuries are normal after a traumatic injury and may change during recovery NICE NG211.
- Splinting and Orthoses: Monitor the pressure effects on the skin caused by orthoses or splints, particularly in individuals with reduced cutaneous sensation or recent skin grafts or flaps NICE NG211. Avoid positions that could lead to loss of function or future complications when using splints or braces to immobilise and protect joints NICE NG211. For upper limb injuries affecting hand and finger movement, offer bespoke (thermoplastic) splints as early as clinically possible to maintain range of movement NICE NG211.
Referral to a specialist should be considered under the following circumstances:
- Complex Hand Injuries: Refer people with complex hand injuries to a hand therapy specialist, as appropriate NICE NG211.
- Pressure Effects from Orthoses/Splints: If monitoring pressure effects on the skin by orthoses or splints, seek advice from tissue viability services and/or plastic surgery specialists as needed NICE NG211.
- Problems with Spinal Orthoses: If spinal orthoses are causing issues such as pain, pressure sores, or swallowing or breathing difficulties, or significantly affecting rehabilitation, inform the relevant surgical team NICE NG211.
- Unexpected Swelling: If alternative medical causes for unexpected swelling, such as deep vein thrombosis, are suspected and require investigation NICE NG211.
- Fragility Fractures: For adults with a fragility fracture, assess bone health and refer as necessary, for example, to a specialist bone health clinic or outpatient service NICE NG211.
- Falls Risk: If a traumatic injury was caused by a fall, ask about previous falls and consider a falls risk assessment and a referral to a community falls service NICE NG211. All adults over 65 who have a traumatic injury should be assessed for their risk of falls NICE NG211.
- Spinal Cord Injury: For people in a trauma unit or major trauma centre who have a spinal cord injury, the trauma team leader should immediately contact the specialist neurosurgical or spinal surgeon on call NICE NG41.
- Unimalleolar Ankle Fractures: Arrange for orthopaedic follow-up within 2 weeks if there is uncertainty about stability NICE NG38. Advise all patients to return for review if symptoms are not improving 6 weeks after injury NICE NG38.