Fractures Care

How fracture care works

Setting a broken bone is only one part of treating a fracture. Care unfolds in stages: understanding how the injury happened and what else may have been damaged, protecting the limb while decisions are made, choosing a method of holding the bone in a good position, then confirming over successive visits that healing is actually taking place. Each stage informs the next, and the plan can change if healing does not go as expected.

A broken bone rarely exists in isolation. The muscle, skin, nerves and vessels around it are injured at the same moment, and the condition of that soft tissue often shapes treatment as much as the fracture pattern does. Bone quality matters too, which is why a break after a minor fall in an older adult may prompt a conversation about bone health. For a description of the injuries themselves, see our page on bone fractures and dislocations.

Reasons people come in for fracture care

• A recent injury diagnosed elsewhere that needs definitive treatment
• A cast, splint or brace needing monitoring or adjustment
• Concern that a bone is not healing, or has healed in a poor position
• Pain, stiffness or weakness persisting after a fracture has been treated
• Irritation from hardware placed at a previous operation

How an injury is assessed

Assessment begins with the history of the injury and an examination that includes circulation, sensation, movement and the state of the skin. Imaging usually starts with X-rays, and views of the joint above and below are often obtained because injuries can extend further than the obvious site. CT may be used when a joint surface is involved, and MRI when a fracture is suspected but not visible. Follow-up imaging is routine, since it is how healing is tracked.

What fracture care can involve

Many fractures are treated without an operation, and non-surgical care is an active process rather than simply waiting.

• Immobilization and support. Casts, splints, braces and slings hold the bone in a protected position.
• Reduction without incision. Displaced fragments can sometimes be guided into better position and held with external support.
• Graduated loading and rehabilitation. Guidance on how much a limb can tolerate is revised at follow-up, and supervised therapy may be recommended once the bone permits.

Operative treatment may be discussed when a fracture cannot be held in acceptable position, when a joint surface is displaced, when the fracture is open, or when earlier treatment has not produced healing.

• Internal fixation. Plates, screws, rods or wires stabilize the bone from within so it heals in the intended alignment.
• External fixation. A frame outside the limb holds the bone through pins or wires, used when soft tissue damage or bone loss makes internal hardware less suitable.
• Staged reconstruction. Complex injuries may be treated in more than one step, with options such as bone grafting where bone is missing.

What to expect when you consult Dr. Wolfson

Dr. Wolfson is board certified in the United States and Canada, and is Chief Editor of the Springer volume Orthopedics in Disasters, a text on treating musculoskeletal injury under difficult conditions. At a consultation he will review your imaging, examine the limb, explain what the fracture pattern means for your choices, and set out a follow-up plan.

This page provides general information about fracture care and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]