Trauma and Fractures

Emergency room – To go or not to go:

Emergency room visits may be expensive and time consuming. If you have been injured and have obvious deformity and severe pain, go to the emergency room. Most fractures with minimal to moderate deformity can be safely treated with elevation, ice and Tylenol or ibuprofen. For ankle injuries, keep weight off the leg. When you call the office, be sure to tell the staff you think you may have a fracture. You may be booked with a physician assistant for faster access. If you have a fracture, one of the doctors will evaluate you as well.

Emergency room follow up at our office:

What to do if you have been or need to go to the emergency room:

  • GET A COPY OF XRAY DISC and REPORT (if possible) before you leave the ER. The hospital DOES NOT SEND these to the office. The doctor will need to review your Xrays to plan treatment.
  • Call the office before you come. Have your ER papers handy when you call – our staff will ask you some questions, and determine the best time for you to arrive. In many cases, a doctor or PA will review your information to determine how soon you should be seen.
    • For many injuries, the best initial treatment consists of the splint applied in the Emergency room and measures to decrease swelling. If that is the case, scheduling your appointment 5-10 days after injury may save you an additional trip to the office.
    • For injuries that may require surgery or if we are unable to determine the nature of your problem before the office visit, you will be scheduled an an emergent basis, in many cases, the same day.
  • If the ER told you you may need surgery, do not eat or drink after midnight, and call the office at 8:30. If you need surgery urgently, an empty stomach may help getting surgery done the same day. The staff will give you further instructions.
    • Be careful if you are diabetic. If you are unable to get instructions by a reasonable time, you may need to eat to prevent low blood sugar.
    • If you are diabetic, or have other significant medical problems, you will be safer if someone is with you to help should something unexpected occur.
  • Control swelling: Elevate broken feet, ankles or wrist above the level of the heart
  • BEWARE TIGHT DRESSINGS. If you have an elastic bandage or dressing, loosen or re wrap it if you notice significant swelling of the fingers or toes.

Collect all of your medication bottles. The doctors will need to review your medications as part of planning your treatment.

About Fractures – Is it fractured or is it broken?

A common question. Actually doctors consider fracture and break to be the same.

Here’s how doctors talk about fractures:. Each of these factors helps the doctor to plan the best way to treat your fracture.

  • Closed vs. Open: Open fractures mean that the bone has pierced the skin, or the bone is “open” to the air. Fortunately, most fractures are closed meaning the skin is intact. Open fractures have a higher risk of infection and problems with healing.
  • Torus or Buckle: Torus or buckle fractures happen in children with growing bones. Sometimes called “greenstick” because these fractures look like the bump that occurs when you try to break a green stick or twig. On xray, there is an irregularity and bump in the bone.
  • Displaced vs. non-displaced: Displacement refers to how close the ends of the fracture or break are to each other and to where they belong. Displaced fractures involve more energy, and may require movement of the bones (manipulation), casting or surgery to achieve satisfactory healing.
  • Angulation: Angulation is similar to displacement. Angulation means that the fracture fragments are at an angle to one another. The angle represents how far the bone has moved relative to where it should be.
  • Comminution: Comminution means many pieces. More pieces may be associated with higher energy trauma, or osteoporosis and results in less stability of the fracture
Other things that influence the choice of treatment and expectation following fractures include the specific location and bone of the fracture, the blood supply to the bones and whether the fracture is close to or disrupts the smooth surface of the bone in a joint.