Fracture care by family physicians. A review of 295 cases

Although many family physicians treat fractures, few studies have examined the fracture care they provide. Specifically lacking is information on clinical outcome and referral patterns.

A retrospective chart review of all fractures diagnosed in a rural family practice residency program during a 31-month period was performed.

Of the 295 patients included in the study, 177 (60%) were managed entirely by family physicians, including 34% of patients with fractures that required reduction. An additional 20 patients (7%) were managed with consultation. Information on outcome was available for 170 (86%) of the patients managed by family physicians with and without consultation. Among patients for whom outcome information was available, 79% had full, good, or excellent range of motion, and 61% were completely asymptomatic. Only four patients had significantly decreased range of motion (ROM), and only 10 had significant symptoms. Most patients with significantly decreased ROM or significant symptoms had fractures that required reduction or fractures of the scaphoid.

In the study setting, family physicians managed a wide range of fractures and achieved good clinical results. These data suggest that family physicians can avoid most poor outcomes by carefully selecting which fractures they manage.