Most fractures treated by Orthopaedic surgeons may be managed with a period of immobilization in a cast followed by gradual progression of range of motion and function. Still others are best managed with surgical intervention. Each fracture is different. Some fractures such as radial head fractures often do not require a cast while others such as tibial plafond fractures often require surgical treatment. With respect to fracture management, there are three important qualities: The personality of the fracture, the overall health of the patient and the surgeon’s ability to treat the fracture. Although we care for many of the tougher fractures and fracture problems that develop, we are fairly conservative with regard to surgical intervention and proceed with or recommend surgery only when there is a clear advantage to surgical repair. The most important part of treatment is that patients feel comfortable and confident with their surgeon. Face to face meetings and discussions are a very important part of the whole equation. We will rarely make a recommendation just looking at an x-ray. We pledge to be as objective, honest and forthright as possible about your care and if we do not know the answer, we are comfortable saying, “I don’t know”.
The personality of the fracture refers to the amount of energy that the involved area has absorbed as a whole. Just as car accidents run the spectrum from minor to severe so does each type of fracture. If the bone is badly splintered on x-ray and the patients skin is blistered from a fall from a height, this is a much more difficult problem to treat than a low energy twisting injury causing a non-displaced spiral fracture. In general, the more severe the injury, the less likely that it will heal without intervention.
Your overall health and occupation is a consideration. The treatment of a proximal humerus fracture in the dominant arm of a 40 year old worker and one in the non dominant arm of a sedentary 85 year old woman are often very different.The goal of the worker is complete recovery at the earliest possible time frame and a very long time horizon, while the goal of treatment in the 85 year old may be centered on pain relief.
Finally, our abilities as surgeons play a role in our recommendations. There are some fractures that can obtain better functional outcome with surgery and there are some that we may refer to another specialist for a second opinion. We do not recommend surgical treatment for everyone.