Musculoskeletal Treatments: Fracture Management

Primary care physicians often serve as the initial point of contact for patients presenting with potential fractures. Initial evaluation with plain radiography or ultrasonography can confirm the diagnosis. If clinical suspicion remains high despite negative imaging, the joint should be immobilized with protected weight-bearing. Then, reassessment should include repeat radiography in 10 to 14 days or advanced imaging with computed tomography or magnetic resonance imaging without intravenous contrast based on location and risk. For fractures that can be managed nonoperatively, the joint should be immobilized with a brace or cast, with short-interval follow-up and repeat radiography. Common indications for referral to an orthopedic surgeon include fractures that are open, displaced, intra-articular, unstable, fracture-dislocations, and those with neurovascular compromise. Fractures with nonunion or malunion should be managed surgically. Rehabilitation is supported by some evidence but requires further research to define optimal protocols for specific fracture types. Special populations, including older adults and athletes, require tailored care plans. Multidisciplinary care has been shown to improve outcomes in patients with complex fractures and in older adults. Racial and ethnic disparities in morbidity and mortality rates associated with fractures highlight the need for improved access to quality care.