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Fracture Management
One place where primary care physicians commonly feel unprepared for is fracture management. However, many routine fractures are easily and safely treated by the PCP, and at substantial savings to the patient. Increasing your comfort with basic fracture management is an easy way to greatly increase the value you offer your patients.
Step One, Resources:
The first resource most family physicians recommend is the book Fracture Management in Primary Care by Eiff and Hatch. This is an invaluable resource, because it not only does a great job of reviewing all common fractures, dislocations, etc, but it helps the physician decide when the injury is appropriate to treat in the PCP environment, and when a referral is indicated. When PCP treatment is indicated, the book details the proper treatment, follow-up frequency, imaging frequency, etc. The second important resource is a good referral base. It is advantageous to have a local/regional orthopedist with whom you are on a first-name basis and have on speed dial. In a tough ortho case, it’s easy to snap a pic of the x-ray, text it to Ortho and ask for advice.
Step Two, Education:
If you need refreshers, go to an ortho refresher/casting/splinting workshop, etc. Or again, befriend an ortho and spend a couple of days in their clinic and have them teach you some stuff. Be creative. Ultimately, the physician will need to get out of his or her comfort zone to some extent if they’re not comfortable with ortho, and soon it won’t be scary.
Step Three: Equipment:
You’ll need casting, splinting, and bracing equipment. There are lots of options here, some are just physician preference. Here is a brief summary of equipment worth having:
- Casting material
- Fiberglass cast rolls (generally 2”, 4” and 6” widths) (Some docs like OsteoFX roll-on casting material--handy but more expensive)
- Cotton roll cast padding (alternative option: Waterproof cast padding-more expensive but often very handy)
- Stockinette (also some various sizes)
- Splinting material
- Padding/splinting combined pre-made splint products: OrthoGlass vs Plaster/foam
- ACE bandages (2”, 4” 6”)
- Finger traps (for setting very common Colles fractures)
- Arm Slings (S, M, L)
- Cast saw (don’t buy a medical cast saw, you can get a reciprocating “multi-tool” saw and half-round blade from a hardware store--same thing, and more than $1,000 less!)
- Braces (wrist braces, aluminum-foam braces, finger braces, mallet finger brace, etc)
All of the materials mentioned are discussed in books such as Pfennniger and Fowler’s Procedures for Primary Care and there are certainly a lot of different options for casting/splinting materials. As always, it is a great idea to have a mentor who is practicing the skills you wish to develop, which can be arranged with ease in the DPC community through online social media and DPCA mentoring/discussion channels, etc. We all want to help!
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Fracture Management
One place where primary care physicians commonly feel unprepared for is fracture management. However, many routine fractures are easily and safely treated by the PCP, and at substantial savings to the patient. Increasing your comfort with basic fracture management is an easy way to greatly increase the value you offer your patients.
Step One, Resources:
The first resource most family physicians recommend is the book Fracture Management in Primary Care by Eiff and Hatch. This is an invaluable resource, because it not only does a great job of reviewing all common fractures, dislocations, etc, but it helps the physician decide when the injury is appropriate to treat in the PCP environment, and when a referral is indicated. When PCP treatment is indicated, the book details the proper treatment, follow-up frequency, imaging frequency, etc. The second important resource is a good referral base. It is advantageous to have a local/regional orthopedist with whom you are on a first-name basis and have on speed dial. In a tough ortho case, it’s easy to snap a pic of the x-ray, text it to Ortho and ask for advice.
Step Two, Education:
If you need refreshers, go to an ortho refresher/casting/splinting workshop, etc. Or again, befriend an ortho and spend a couple of days in their clinic and have them teach you some stuff. Be creative. Ultimately, the physician will need to get out of his or her comfort zone to some extent if they’re not comfortable with ortho, and soon it won’t be scary.
Step Three: Equipment:
You’ll need casting, splinting, and bracing equipment. There are lots of options here, some are just physician preference. Here is a brief summary of equipment worth having:
- Casting material
- Fiberglass cast rolls (generally 2”, 4” and 6” widths) (Some docs like OsteoFX roll-on casting material--handy but more expensive)
- Cotton roll cast padding (alternative option: Waterproof cast padding-more expensive but often very handy)
- Stockinette (also some various sizes)
- Splinting material
- Padding/splinting combined pre-made splint products: OrthoGlass vs Plaster/foam
- ACE bandages (2”, 4” 6”)
- Finger traps (for setting very common Colles fractures)
- Arm Slings (S, M, L)
- Cast saw (don’t buy a medical cast saw, you can get a reciprocating “multi-tool” saw and half-round blade from a hardware store--same thing, and more than $1,000 less!)
- Braces (wrist braces, aluminum-foam braces, finger braces, mallet finger brace, etc)
All of the materials mentioned are discussed in books such as Pfennniger and Fowler’s Procedures for Primary Care and there are certainly a lot of different options for casting/splinting materials. As always, it is a great idea to have a mentor who is practicing the skills you wish to develop, which can be arranged with ease in the DPC community through online social media and DPCA mentoring/discussion channels, etc. We all want to help!