Acute pain management
Open<unk> s require immediate IV antibiotics and urgent surgical washout
Neurovascular compromise from<unk>  requires emergent reduction and/or orthopedic intervention
Consider risk for compartment syndrome
Acute reduction indicated:
Pseudo-clawing
Significant angulation (>10-15 degrees of the 2nd through 4th fingers, 20-30 degrees of the 5th) 
Any rotational misalignment
Reduction technique:
Pain control and/or Hematoma block
Flex MCP joint to 90 degrees then apply axial traction while placing pressure over metacarpal shaft
Radial gutter splint if 2nd/3rd MCP<unk> s, Ulnar gutter splint if 4th/5th. Immobilize with wrist extended 20-30 degrees and MCP flexed 90 degrees
Can be difficult to reduce or maintain reduction. Early hand referral if not successful
Pseudo-clawing
Significant angulation (>10-15 degrees of the 2nd through 4th fingers, 20-30 degrees of the 5th) 
Any rotational misalignment
Pain control and/or Hematoma block
Flex MCP joint to 90 degrees then apply axial traction while placing pressure over metacarpal shaft
Radial gutter splint if 2nd/3rd MCP<unk> s, Ulnar gutter splint if 4th/5th. Immobilize with wrist extended 20-30 degrees and MCP flexed 90 degrees
Can be difficult to reduce or maintain reduction. Early hand referral if not successful
Ulnar Gutter Splint or Radial Gutter Splint
MCP joints in 70-90 deg flexion, wrist in 20-30 deg extension, PIP and DIP joints in 5-10 deg of flexion
MCP joints in 70-90 deg flexion, wrist in 20-30 deg extension, PIP and DIP joints in 5-10 deg of flexion
Non-thumb metacarpal fracture 
Non-thumb metacarpal fractures
Humerus shaft fracture
Head
Humerus shaft fracture 
Neck
Tibial tuberosity fracture
Shaft