Trauma and Fracture Care
The aim of fracture treatment is not only for the bone to unite; it is to regain the function that existed before the fracture. The treatment plan therefore considers the surrounding soft tissue, joint movement and the patient’s daily requirements alongside the bone itself.
How Is the Decision Made?
Not every fracture needs surgery, and not every fracture can be treated in a cast. The main factors determining the decision are:
- The site of the fracture: fractures extending into a joint are handled differently, because the joint surface must be restored accurately
- The amount of displacement and the alignment
- Whether the fracture is comminuted
- The state of the soft tissues: an open fracture, marked swelling or a skin problem changes the timing
- Bone quality: the presence of osteoporosis affects the method of fixation
- The patient’s age, accompanying conditions and functional expectations
Treatment Options
Non-surgical treatment
In stable fractures with little displacement and acceptable alignment, a cast or splint is used. Regular follow-up matters during this period: a fracture can shift in the first weeks and the fit of the cast changes as swelling settles. For details of cast care see the Cast and Splint Care Guide.
Surgical treatment
Surgical fixation is considered where displacement is marked, the joint surface is disrupted, the fracture is unstable, or early movement and weight-bearing are required. Plates and screws, intramedullary nails and external fixation are chosen according to the characteristics of the fracture.
In hip fractures in older patients the general approach is a plan that allows the patient to be got up early; prolonged bed rest brings problems of the lungs, circulation and skin with it.
Factors Affecting Healing
- Smoking: one of the strongest modifiable factors adversely affecting fracture healing
- Diabetes and nutritional status
- Vitamin D and calcium levels
- The state of the soft tissue and circulation at the fracture site
- Adherence to the treatment plan and weight-bearing instructions
Stiffness After a Fracture: the Quiet Problem
A frequently overlooked issue in fracture treatment is the joint stiffness and muscle loss that remain after the bone has united. Particularly after fractures of the wrist, elbow and shoulder, regaining range of movement can take longer than the bone takes to heal.
The treatment plan therefore also covers which joints can be moved immediately after fixation. Doing the movements your physician permits, regularly, is decisive for the final result.
Preventing a Second Fracture
If a fracture has occurred from a low-energy injury — for example a fall from standing height — this is a warning with regard to osteoporosis. Assessing bone health and reducing the risk of falls is as important as treating the fracture.
When Should You Seek Assessment?
- If you cannot bear weight or use the limb after an injury
- If there is obvious deformity, marked swelling or bruising
- If pain increases rather than decreases while in a cast
- If numbness, coldness or colour change develops in the fingers or toes
- If your joint movement has remained restricted although the fracture has healed
When to Seek Medical Help Without Delay
- Open fracture — bone breaking through the skin, or an open wound at the fracture site
- Coldness, pallor, loss of sensation or absence of a pulse in the limb
- Increasing pain in a cast that is not relieved by medication, with tense swelling (a warning of compartment syndrome)
- Altered consciousness, breathlessness or abdominal pain after major trauma
- After a fall, the leg appearing short and rotated outwards (suspected hip fracture)
These findings require urgent assessment. Outside office hours, go to the nearest emergency department.
Frequently Asked Questions
Does every fracture need surgery?
No. In stable fractures with little displacement and acceptable alignment, a cast or splint is sufficient. Surgery is considered for marked displacement, disruption of the joint surface, unstable fractures and where early movement is needed.
How long does a fracture take to unite?
The timeframe varies with the site and type of fracture, age, bone quality and accompanying conditions. For that reason no single period is given. Healing is monitored with follow-up films.
Why will my joint not move after the cast comes off?
In an immobilised joint the capsule and soft tissues shorten and the muscles weaken. This is expected and is addressed with a graded movement and strengthening programme; the process can take longer than the bone takes to unite.
Does smoking affect fracture healing?
Yes. Smoking is one of the strongest modifiable factors adversely affecting fracture healing. Stopping during the healing period is particularly recommended.
Should plates and screws be removed later?
Not always. The decision weighs the patient’s symptoms, the site of the implant, age and bone condition. Routine removal is not recommended.
Can I move my fingers while in a cast?
Unless your physician says otherwise, moving the joints outside the cast is recommended; this reduces swelling and prevents stiffness. Seek advice if pain increases or numbness begins.
Academic Work
Assoc. Prof. Bertan Cengiz, MD has scientific work published in national and international peer-reviewed journals in the field of trauma surgery and fracture care and related areas. The publication list and verifiable academic sources are available on the Publications page.
Related Pages
- Fractures Related to Osteoporosis
- Ankle Sprain
- Achilles Tendon Injuries
- Joint Replacement Surgery (Knee, Hip and Shoulder Arthroplasty)
- Shoulder and Upper Extremity
The information on this page is for general guidance and does not replace an in-person medical examination. Diagnosis and treatment require a physician’s clinical assessment. Outcomes of any treatment or surgical intervention may vary from person to person; no guarantee of a specific result or timeframe is given on this page.