Dr Soubrane Philippe

Management of Common Orthopaedic Fractures

Overview

Fractures are breaks in the continuity of bone and commonly result from trauma such as falls, road traffic accidents, or sports injuries. They may range from simple, stable injuries to complex fractures requiring urgent surgical intervention.The goal of treatment is to restore anatomical alignment, promote bone healing, relieve pain, and enable early return to function.

Common Types of Fractures Managed

A wide range of fractures across different anatomical regions are routinely treated:

Upper Limb

  • Clavicle fractures
  • Proximal humerus fractures
  • Distal humerus fractures
  • Shaft humerus fractures
  • Elbow fractures (including supracondylar fractures)
  • Forearm fractures (radius and ulna)
  • Distal radius fractures (Colles’, Smith’s)
  • Scaphoid fractures
  • Metacarpal fractures (including boxer’s fracture)
  • Phalangeal fractures

Spine

  • Unstable cervical spine fractures (requiring posterior fixation)
  • Thoracolumbar fractures (compression, burst fractures)

Pelvis and Hip

  • Pelvic ring injuries
  • Acetabular fractures
  • Femoral neck fractures
  • Intertrochanteric fractures
  • Subtrochanteric fractures

Lower Limb

  • Femoral shaft fractures
  • Distal femur fractures
  • Patella fractures
  • Tibial plateau fractures
  • Tibial shaft fractures
  • Pilon (distal tibia) fractures
  • Ankle fractures (uni-, bi-, trimalleolar)
  • Calcaneus fractures
  • Talus fractures
  • Metatarsal fractures
  • Phalangeal fractures (toes)

Clinical Presentation

Patients with fractures typically present with:

  • Pain at the site of injury
  • Swelling and bruising
  • Deformity or abnormal positioning
  • Loss of function or inability to bear weight
  • Tenderness on palpation
  • Open wounds in open fractures

Diagnosis

Clinical Evaluation

  • Mechanism of injury assessment
  • Inspection for deformity and swelling
  • Palpation and functional assessment
  • Neurovascular examination
  • Screening for associated injuries

Imaging

  • X-rays – First-line investigation
  • CT scan – For complex or intra-articular fractures
  • MRI – Selected cases (occult fractures, soft tissue injury)

Non-Surgical Management

Stable and minimally displaced fractures may be treated conservatively:

  • Immobilization with casts or splints
  • Functional bracing
  • Pain control
  • Physiotherapy

Surgical Management

Surgical treatment is indicated for displaced, unstable, or complex fractures.

Common techniques include:

  • Plate and screw fixation
    • Clavicle, humerus, forearm, periarticular fractures
  • Intramedullary nailing
    • Femur and tibia shaft fractures
  • Dynamic Hip Screw (DHS)
    • Stable intertrochanteric fractures
  • Proximal Femoral Nail Antirotation (PFNA)
    • Unstable intertrochanteric fractures
  • Cannulated screws
    • Femoral neck, scaphoid fractures
  • External fixation
    • Temporary or definitive stabilization in trauma
  • Posterior cervical fixation
    • Unstable cervical spine injuries

The choice of treatment depends on fracture pattern, patient factors, and functional requirements.

Expected Outcomes

With appropriate management, most fractures heal successfully.

Expected outcomes include:

  • Pain relief
  • Restoration of anatomical alignment
  • Recovery of function
  • Return to daily activities

Risks and Complications

Potential complications include:

  • Infection
  • Delayed union or non-union
  • Malunion
  • Neurovascular injury
  • Implant-related complications
  • Joint stiffness
  • Post-traumatic arthritis

Rehabilitation and Recovery

Rehabilitation plays a crucial role:

  • Early mobilization when appropriate
  • Progressive strengthening exercises
  • Restoration of joint motion
  • Gradual return to activity


Recovery timelines vary depending on fracture type and treatment.

Prognosis

Most patients achieve good functional recovery with timely and appropriate treatment. More complex injuries may require longer rehabilitation and multidisciplinary care.

Summary

Common orthopaedic fractures encompass a wide range of injuries affecting the upper limb, spine, pelvis, and lower limb. Individualized treatment—whether conservative or surgical—combined with structured rehabilitation ensures optimal recovery and return to function.