Immediate Treatment for FOOSH Injury
Do not attempt to straighten or move the injured extremity; instead, splint it in the position found, activate EMS if the hand appears blue or pale, and apply ice with a barrier for pain control while awaiting definitive care. 1
Initial Assessment and Action
Assess vascular status immediately - if the injured extremity appears blue or extremely pale, activate emergency medical services without delay, as this indicates potential vascular compromise requiring urgent intervention. 1
Do not manipulate the injury - first aid providers should not move or attempt to straighten an injured extremity, as this can cause further harm including neurovascular injury. 1 This recommendation stands even in the presence of deformity, unless you are in a remote/wilderness setting far from EMS access.
Immobilization
Splint in the position found to limit pain, reduce the chance for further injury, and facilitate safe transport. 1 The splint should:
- Extend beyond the injury site to include adjacent joints for stability 2
- Be well-padded to prevent skin breakdown 3
- Not be overtightened, as this can compromise circulation 3, 2
Pain and Swelling Management
Apply ice with a protective barrier between the cold source and skin to prevent tissue damage. 1 Based on evidence for soft tissue injuries:
- Use melting iced water through a wet towel 4
- Apply for repeated 10-minute intervals rather than continuously 4
- Avoid direct ice application to skin, which can cause tissue ischemia 1
Elevate the injured extremity to reduce swelling. 1
Critical Pitfalls to Avoid
- Never straighten angulated fractures - there is no evidence supporting this practice in first aid settings, and it carries significant risk of neurovascular injury 1
- Do not apply compression bandaging alone without proper splinting, as the extremity needs immobilization 1
- Avoid prolonged continuous ice application - reflex activity and motor function are impaired for up to 30 minutes following ice treatment, potentially increasing reinjury risk 4
Transport and Follow-up
Arrange immediate transport to emergency care for radiographic evaluation and definitive management. 3 FOOSH injuries commonly result in fractures of the distal radius, scaphoid, or other carpal bones that require imaging for proper diagnosis.
If surgical hardware is involved or protruding (in cases of prior wrist surgery), ensure close follow-up within 24-48 hours if immediate surgical intervention cannot be performed. 3