General principles of definitive fracture management
- Anthony Beutler, MD
Anthony Beutler, MD
- Associate Professor of Family Medicine
- Uniformed Services University
- Stephen Titus, MD
Stephen Titus, MD
- Assistant Professor of Family Medicine
- Fort Belvoir Community Hospital Family Medicine Residency
- Uniformed Services University of the Health Sciences
Immobilization provides the basis for fracture healing. For many complex and unstable fractures, immobilization is achieved by means of internal fixation. However, many stable fractures at low risk of displacement can be immobilized effectively with casting, which can be performed by orthopedists or knowledgeable primary care clinicians.
The basic principles and techniques of casting and the follow-up care needed for patients treated in this manner are reviewed here. The assessment and initial management of acute fractures is discussed separately. (See "General principles of fracture management: Bone healing and fracture description" and "General principles of acute fracture management".)
Overview — Casting is standard treatment for many closed, nondisplaced, or reduced fractures . Casts provide a stable, protected environment in which the external, periosteal callus can form and normal bone healing can proceed .
The optimal time to place a cast is after post-traumatic swelling has resolved. This usually takes five to seven days following an injury but varies depending upon the location and type of fracture. Most often a splint is used in the interim. Nevertheless, several fracture types are best managed with acute casting. In such cases, the casts are either maintained in a single piece or converted into functional splints by creating “valves” in the cast (ie, two incisions along the entire length, thereby dividing the cast into two pieces) that can accommodate some soft tissue swelling.
Fractures likely to require casting acutely include those with the following characteristics :
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- Type of cast
- Application of cast
- Keeping casts dry
- FOLLOW-UP VISITS
- Follow-up visits for stable fractures
- Follow-up visits for unstable fractures
- Orthopedic referral
- FRACTURE HEALING
- Biology of fracture healing
- Clinical assessment of fracture healing
- ADJUNCTIVE THERAPY FOR FRACTURE HEALING
- Overview and basic measures
- Pharmacologic adjuncts
- - Systemic therapies
- - Local therapies
- Prevention of complex regional pain syndrome
- Nonpharmacologic adjuncts
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS