Fracture Treatment: What Your Doctor Will Do

Clinical Fracture Management Pathway

From diagnosis to return to function – the orthopedic algorithm.

1. Assessment & Diagnosis

• History: mechanism, pain, function.
• Exam: deformity, swelling, neurovascular status, compartments.
• Imaging: X‑ray (AP/lateral/oblique) → CT for intra‑articular/complex → MRI for occult/stress.

2. Reduction (If Displaced)

• Closed reduction: sedation/analgesia + manual realignment.
• Open reduction (ORIF): surgical exposure + fixation.
• Goal: anatomic alignment, joint congruity, rotational correction.

3. Immobilization

Method	Indications
Cast (fiberglass/plaster)	Stable, reduced fractures
Functional brace	Tibial shaft, humeral shaft
External fixation	Open fractures, severe soft tissue injury, damage control
Internal fixation (plates, screws, nails)	Unstable, intra‑articular, early mobilization needed

4. Monitoring

• Weekly X‑rays early → biweekly → monthly.
• Assess callus formation, alignment maintenance, hardware integrity.

5. Pain Control

• Multimodal: acetaminophen + NSAID ± short‑course opioid (3‑5 days).
• Regional blocks (femoral, fascia‑iliaca) for femur/hip.

6. Rehabilitation

• Phase 1: Protect, edema control, isometrics.
• Phase 2: ROM, progressive weight‑bearing.
• Phase 3: Strength, proprioception, functional tasks.
• Phase 4: Return to sport/work.

7. Surgical Indications

• Open fracture (Gustilo I‑III).
• Unstable / irreducible.
• Intra‑articular step‑off >2 mm.
• Multiple fractures / polytrauma.
• Pathologic / impending fracture.

Shared decision‑making ensures treatment aligns with patient goals, comorbidities, and social context.