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Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

RHCG Fracture Management Guidance (940)

Always consider Non-Accidental Injury

If any neurovascular compromise keep patient nil by mouth and discuss with orthopaedics

For open fractures ensure normal principles are followed: photograph if possible, cover and administer antibiotics.

Upper Limb

Diagnosis

 

Management

Follow up

Parental advice

Clavicle fracture

 

Broad arm sling/polysling

If skin compromise discuss with orthopaedics

 

Routine follow up not required

VFC significantly displaced adolescent fractures

Advice leaflet (pdf)

AC joint disruption

 

Broad arm sling

Physio referral for follow up

 

Shoulder soft tissue injury

 

Broad arm sling

Physio referral for follow up

Gentle mobilisation as able

Shoulder dislocation

 

Reduction in ED or MIU, polysling

Physio referral

Face to face fracture clinic 2 weeks

 

Humeral Fracture


 

 

Proximal

Collar and cuff

VFC Review

Analgesia, advise to sleep inclined at about 45 degrees

Start gentle mobilisation at 14 days

Shaft

Assess radial nerve; inform ortho if not intact. Humeral brace and collar and cuff or long back slab plus sling.

Face to Face fracture clinic 2 weeks

Analgesia, tight T-shirt may help. Keep sling on.

Elbows

 

 

 

 

Elbow dislocation

 

Reduce and apply backslab and provide collar and cuff;

Xray and call for Ortho assistance if not reducible.

No ortho involvement in ED then VFC

Ortho involved in ED then as per their instructions 

 

Elbow Injury

 

Effusion, posterior fat pad; no definite fracture seen

Collar and cuff

No follow-up

 

Mobilisation advice as able.

Supracondylar Humeral Fracture

 

 

Gartland 1
Undisplaced

Collar and cuff

No follow-up

Analgesia, advise to mobilise at 3 weeks and avoid jumping/falling for 6 weeks

Gartland 2
Minimally displaced

Apply backslab at more than 90 degrees then check x-ray

VFC

 

Gartland 2
Significant displacement
(Anterior humeral line does not pass through the capitellium)

Apply backslab in current position and contact ortho

Likely for surgical intervention

FU As per ortho

 

Gartland 3+
Markedly displaced

Document neurovascular assessment.

Apply backslab in current position

Call Ortho

Likely for surgical intervention

FU As per ortho

 

Lateral condyle fracture

Undisplaced

Backslab

Face to Face fracture clinic 1 week

 

Displaced

Backslab for comfort

Call ortho.

Likely for surgical intervention

FU As per ortho

 

Medial Epicondyle Fracture

Displaced/undisplaced

Check Ulnar nerve

Intact: backslab
Not: contact ortho

Face to face fracture clinic 1 week

 

Radial Neck Fracture

Undisplaced, angulated <25 degrees, not involving joint surface

Collar and cuff

 

No Follow-up

Mobilise as pain allows, discard sling after 14 days

Angulation, displacement  or intra-articular

Discuss with Orthopaedics

    

Forearm/Wrist Fractures

Look for Galeazzi/Monteggia patterns

Monteggia/Galeazzi
Call ortho

Follow up as per operative instructions

 

Forearm shaft

ALWAYS CHECK RADIOCAPITELLAR LINE!

 

 

No Clinical Deformity

 

Long arm complete cast

Face to Face fracture clinic 1 week

 

Clinical deformity

 

Discuss with orthopaedics for decision:

Consider manipulation under Entonox or Ketamine if appropriate.
May require admission and operative management.

As per orthopaedics

 

 

Wrist
Distal radius/ulna

 

Buckle fracture

 

Wrist splint 3 weeks

 

No follow-up

Parents advised to remove splint in 3 weeks (and give leaflet)

Undisplaced

Wrist splint

 

No follow-up

Parents advised to remove splint in 3 weeks

Displaced

Discuss with orthopaedics for decision:

Consider manipulation under Entonox or Ketamine if appropriate.
May require admission and operative management.

As per ortho

 

Wrist: Physeal injury

 

Undisplaced 

Backslab or removable splint

VFC

 

Displaced

Discuss with orthopaedics for decision:

Consider manipulation under Entonox or Ketamine if appropriate.
May require admission and operative management.

As per ortho

 

Scaphoid (Suspected>10 years)

Clinical

Wrist splint

Face to Face fracture clinic 10 – 14 days

 

Lower Limb

Diagnosis

 

Management

Follow up

Parental advice

Hip

SCFE

Call Ortho

Likely for surgical intervention

FU As per ortho

 

Femur

Neck

Call Ortho

Likely for surgical intervention

FU As per ortho

 

Shaft

 

Femoral nerve block and Thomas splint.

Liaise with ortho

Likely for surgical intervention

FU As per ortho

 

Distal femur

Call Ortho

As per ortho

 

Knee

Intra-articular fracture

Call Ortho

Likely for surgical intervention

FU As per ortho

 

Small effusion, weight bearing, no fracture

Soft tissue advice

Refer to Physio

 

  

Effusion, non weight bearing +/- fracture

Knee splint

Refer to Physio

Face to Face fracture clinic 1 week

 

Patella dislocation

Reduce

 Physio referral

  

 

Patella Fracture

Undisplaced – splint

Displaced – call ortho

Sleeve – call ortho

Physio referral, VFC

As per ortho

As per ortho

  

 

Tibial tuberosity

Undisplaced – splint

Displaced – Call ortho

VFC

As per ortho

  

 

Tibial Eminence

Call Ortho

As per ortho

  

Tibia

 

 

 

 

 

 

 

Undisplaced shaft

Long leg full cast with ortho assistance as required

Face to Face fracture clinic 1 week

Physio referral

Elevate; To return if pain increases

Displaced shaft +/- fibula fracture

 

Call Ortho

As per ortho

 

Toddler fracture

Walking boot or if none small enough apply full cast

Face to face fracture clinic 3 weeks

 

Isolated fibular shaft fracture

Check ankle joint

Symptomatic treatment and walking boot.

Physio referral

VFC

 

Ankle

 

Ankle sprain

 

Symptomatic treatment

Physio referral

General soft tissue injury advice re rest, ice, elevation and maintain good ROM

Undisplaced Distal fibula fracture (isolated)

Walking boot

Physio referral

Remove boot 4 weeks

Advise to discard boot at 4 weeks and refrain from sport for 6 weeks

 

Displaced distal fibula fracture

Walking boot 

Physio Referral

Face to face fracture clinic 1 week

Any displaced distal tibia growth plate injury

Call ortho

As per post-reduction advice

 

Foot
Metatarsals

 

 

 

5th metatarsal Jones fracture in adolescent

Walking boot 4 weeks

Phsyio referral

Opt in fracture clinic

Weight bear as able

Base of 5thmetatarsal avulsion fractur

Walking boot

Nil

Weight bear as able in walking boot for 2 weeks and then trainer for 2 weeks

Isolated, undisplaced metatarsal shaft fracture

Walking boot

No follow-up

 

Multiple displaced metatarsal shaft fractures

Call ortho

As per ortho

 

Midfoot

Lisfranc injury (unstable; swelling+)

Call ortho

As per ortho

  

Calcaneum

Undisplaced

If undisplaced, walking boot

Assess for other injuries.

Physio referral

 

Displaced

Call ortho

As per ortho

 

Great toe

 

No deformity

Symptomatic treatment

Nil

Mobilise, symptoms for up to 6/52

Clinical deformity

Manipulate with ring block/entonox, elastoplast toe spica +/- moonboot

Nil

Remove boot at 3 weeks and mobilise as able

Other toes

Clinical deformity

X-ray, reduce as needed and buddy strap

No follow up needed

Mobilise, symptoms for up to 6/52

No deformity

No x-ray needed, buddy strap for comfort

No follow up needed

Mobilise, symptoms for up to 6/52

Specific patient injury pathways

Limps: These should be given an opt-in letter as usual. If they contact the ED secretary asking for a review they will also be added on to the next VFC and will be contacted by the orthopaedic team

Editorial Information

Last reviewed: 22/07/2022

Next review date: 22/07/2025

Author(s): Ms Kim Ferguson (Consultant Orthopaedic Surgeon, RHCG) on behalf of RHCG Orthopaedic Service.

Version: 2

Document Id: 940