If a pt came with Accidental fall ,but no fracture ,swelling of affected area What will be rx
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soft tissue injury treatment no fracture swelling RICE NSAID 2024 guidelines
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Here is the complete management for a patient with a fall, no fracture, with swelling (soft tissue injury - contusion/sprain):
Rx: Soft Tissue Injury (No Fracture, with Swelling)
1. Immediate / Acute Phase (0-72 hrs) - RICE / PEACE
The classic approach is RICE; updated guidelines now prefer PEACE:
| RICE (Classic) | PEACE (Updated) |
|---|---|
| Rest | Protect - limit movement 1-3 days |
| Ice - 15-20 min, every 2 hrs | Elevate - above heart level |
| Compression - crepe/elastic bandage | Avoid anti-inflammatories (see note) |
| Elevation - above heart | Compress with elastic bandage |
| Educate patient |
Note on Anti-inflammatories: Current evidence suggests NSAIDs may impair tissue healing in the early phase. However, for pain control in routine clinical practice, short-course NSAIDs are still widely used.
2. Pharmacological Treatment
For Pain & Swelling:
- Paracetamol (Acetaminophen) 500-1000 mg TDS/QID - first-line analgesic (safest)
- NSAIDs (if no contraindications):
- Ibuprofen 400 mg TDS x 3-5 days (with food)
- Diclofenac 50 mg BD/TDS x 3-5 days
- Naproxen 250-500 mg BD
- Topical NSAIDs (preferred to reduce systemic effects):
- Diclofenac gel / Ibuprofen gel - apply TDS to affected area
- Serratiopeptidase or Trypsin-Chymotrypsin - for swelling/oedema reduction (commonly used in South Asian practice)
For Muscle Spasm (if present):
- Muscle relaxant: Methocarbamol, Cyclobenzaprine, or Chlorzoxazone
3. Subacute Phase (Day 3 onwards) - LOVE
LOVE protocol after acute phase:
- Load - gradual return to activity, early mobilization
- Optimism - encourage positive mindset
- Vascularization - pain-free cardiovascular activity (walking, cycling)
- Exercise - restore mobility, strength, proprioception
4. Physical Measures
- Cold pack first 48-72 hrs (vasoconstriction, reduces swelling)
- Warm compress/heat after 72 hrs (vasodilation, promotes healing)
- Physiotherapy/Exercise rehabilitation for sprains especially
- Compression bandage to reduce swelling and provide support
5. Indications for Re-evaluation / Referral
Refer or reassess if:
- Swelling worsening or not resolving after 5-7 days
- Neurovascular compromise (numbness, pallor, cold limb)
- Inability to bear weight (re-examine for occult fracture)
- Suspected ligament rupture or compartment syndrome
- X-ray or MRI needed if Ottawa rules criteria met
Summary Prescription (Typical)
| Drug | Dose | Duration |
|---|---|---|
| Tab. Ibuprofen 400 mg | TDS after food | 5 days |
| Tab. Paracetamol 500 mg | TDS | 5 days (for breakthrough pain) |
| Diclofenac gel 1% | Apply TDS locally | 7 days |
| Tab. Pantoprazole 40 mg | OD (gastroprotection with NSAID) | 5 days |
| Crepe bandage | Compression | Till swelling reduces |
- RICE/PEACE instructions to patient
- Elevate the limb when resting
- Review after 5-7 days
Sources: Campbell's Operative Orthopaedics 15th Ed 2026 (RICE for soft tissue injuries); Swanson's Family Medicine Review (compression/elevation for swelling control); PEACE & LOVE updated framework (Summit Orthopedics, 2024)
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