St Michael’s Limb Trauma Unit
Background
The new unit will aim to provide medical care for patients with significant isolated limb injuries which require care beyond that which can be normally delivered within the Cornwall network of Minor Injury Units and West Cornwall Hospital. Providing this care at a different site from the Emergency Department at Treliske will allow patients with significant limb trauma to continue to receive timely treatment irrespective of the demands of COVID-19 on the Cornwall healthcare system. The new unit will be supported by 2 on-site operating theatres, 2 wards (for adult inpatients only), on-site orthopaedic staff 24/7 and co-located Virtual Fracture Clinic and Hand Clinic. There is X-ray available 24/7, but no CT or MRI. 4 units of O negative blood are held at the hospital, but blood tests require to be sent and processed at Treliske.
Method of referral
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Directly by ambulance for limb trauma which is obviously beyond the capability of Minor Injury Units, but not requiring facilities at Treliske.
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Referral from Minor Injury Units and West Cornwall Hospital (always after discussion with the orthopaedic team at St Michael’s Hospital) for patients whose care cannot be completed at those facilities and who cannot wait for follow up in the Virtual Fracture Clinic or Hand Clinic.
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Self-referrals – depending upon the nature of the injury and the state of the Unit, patients may be treated within the Unit or redirected to local Minor Injury Units. It is not anticipated that a primary function of this Unit will be to duplicate care already available at local Minor Injury Units.
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Typical appropriate presentations include patients aged >15yrs with suspected:
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Hip fracture
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Hip prosthesis dislocation or periprosthetic fracture
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Isolated femoral shaft fracture with no other injuries
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Significant knee fractures/injuries
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Tibial shaft fracture
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Ankle fracture/dislocation (including those requiring MUA)
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Significant foot fractures/dislocation (eg Lisfranc)
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Shoulder dislocation
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Humeral shaft fracture
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Elbow dislocation
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Forearm fracture
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Wrist fracture requiring MUA
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Wrist/carpal bone/MC dislocation
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Open fracture not requiring treatment at Treliske/Derriford
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Tendon injury requiring exploration/repair
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Septic arthritis
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Infected wounds which cannot be managed at MIU
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Deep/extensive soft tissue wounds which cannot be managed at MIU
For children who present to the ambulance service with any of the above conditions, SWAST should telephone St Michael’s hospital to discuss with the orthopaedic team where the child should be taken for initial and definitive care.
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Presentations not suitable for management at St Michael’s include suspected:
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Major trauma
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Head injury with GCS <15
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Cauda equina syndrome
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Spinal injury
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Post-concussional syndrome
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Significant burns
NB: We will have difficulty with operating on pregnant patients, and those with ICDs - although we can still see them in the injuries unit and discuss them with the MIUs, but if surgery required will need to be done at Treliske.
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Fragility Fracture pathway for St Michael's
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