Fracture assessment and diagnosis
A fracture is suspected when pain, swelling and tenderness follow an injury, particularly if there is deformity, inability to use the limb, or bony tenderness at a specific point. X-rays are the first-line investigation and identify most fractures. However, some fractures (stress fractures, certain wrist and hip fractures in the elderly) may not be visible on initial X-rays and may require follow-up imaging or MRI.
Accurate classification of the fracture — location, pattern, displacement, and whether the skin is broken (open vs closed) — determines the treatment approach. Some fractures can be managed with immobilization alone; others require surgical fixation to restore alignment and allow early mobilization.
- Wrist fractures (distal radius) — common after falls on an outstretched hand
- Ankle fractures — range from stable (non-displaced) to unstable requiring surgery
- Hip fractures — common in elderly patients with osteoporosis, often requiring urgent surgery
- Arm and humerus fractures — managed conservatively or surgically depending on pattern
- Stress fractures — overuse injuries, common in runners and athletes
- Metatarsal and foot fractures — often from direct trauma or repetitive loading
Related: Orthopedics → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
Treatment principles
The goal of fracture treatment is to restore alignment, maintain stability, and allow the bone to heal in a position that restores function. Non-surgical treatment (casting, splinting, bracing) is appropriate for stable, non-displaced fractures where alignment can be maintained without surgery.
Surgical treatment (open reduction and internal fixation — ORIF) is used for displaced, unstable or intra-articular fractures where non-operative treatment would result in malunion, non-union or poor functional outcome. The choice of implant (plates, screws, nails, wires) depends on the fracture pattern and location. Post-operative rehabilitation is essential for optimal recovery.
| Fracture type | Typical treatment | Healing time (approximate) |
|---|---|---|
| Distal radius (wrist) | Cast or ORIF | 6–8 weeks |
| Ankle (stable, non-displaced) | Cast or boot | 6–8 weeks |
| Ankle (unstable) | ORIF with plates and screws | 8–12 weeks |
| Metatarsal (non-displaced) | Weight-bearing as tolerated, boot | 4–6 weeks |
| Stress fracture | Activity modification, protected weight-bearing | 6–8 weeks |