Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.

Miho J. Tanaka, MD, is a board-certified orthopedic surgeon who specializes in the treatment of sports medicine injuries.

Broken bones are one of the most common orthopedic injuries. Fractures require treatment which may be as simple as rest, or as invasive as surgery. There are many factors that must be considered to determine the most appropriate treatment of a broken bone including:

Some of the most frequently used fracture treatments are described here.

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The most common type of fracture management is with immobilization. There are different types of immobilization including splint, braces, casts, slings, and others.

Cast immobilization is the most common method where a material (typically plaster or fiberglass) is wrapped around an injured extremity and allowed to harden. Casts come in an endless number of shapes and sizes and require proper cast care.

Fractures treated with immobilization must be adequately aligned to allow for healing with good results. If the alignment of the fracture is not sufficient, further treatment may be needed.

A procedure called a fracture reduction, or reducing a fracture, is an intervention to better align the broken bones. A fracture reduction can either be done as a closed reduction (nonsurgical) or an open reduction (surgery).

A typical closed reduction is performed either by providing local anesthetic to the broken bone or a general anesthesia, followed by a specific maneuver to attempt to realign the broken bone. After a closed reduction, a splint or cast would be applied to hold the bones in the improved alignment while they heal.

Traction is an older form of fracture management that is used much less commonly today. However, there are certain situations where traction can be a very useful treatment option.

Traction involves gentle pulling of the extremity to align the bones. Often a metal pin is placed in the bone away from the fracture, this is called skeletal traction. Ropes and weights are attached to the pin to gently pull and hold the bone fragments into alignment.

Skin traction is a similar concept, but instead of a pin being inserted into the bone, the traction is placed by pulling externally on the extremity. Skin traction cannot pull with as much force as skeletal traction, so if traction is being used for more than a short time, usually skeletal traction is favored.

Pins can be used to stabilize bones when a closed reduction is used to improve alignment, but a cast is insufficient to hold the bones in place.

Pins are typically placed through the skin in a procedure called a closed reduction with percutaneous pinning (CRPP). The pins are placed in the operating room, but can typically be removed in your healthcare provider's office and there is little discomfort in most pin removal procedures. If there is discomfort, the removal can be performed in the operating room.

External fixation also uses pins that enter the skin but are held together outside the body with a frame to maintain alignment. External fixation can be an excellent option in cases of trauma as they can be applied quickly, they can be adjusted as needed, and they allow access to the skin and soft-tissue wounds. External fixation is often used with open fractures (vs. closed fractures).

External fixation can also be helpful when there is significant swelling that could make surgery too risky. By temporarily immobilizing the fracture, the swelling can improve, and internal fixation can be considered at a later time.

Open reduction with internal fixation (ORIF) means to surgically open the site of the fracture, align the bone fragments, and then hold them in place. The most common type of internal fixation are metal plates and screws, although there are many devices that can be used to stabilize different types of fractures.

(ORIF) is the preferred treatment for a number of different types of fractures:

Determining when a fracture should have surgery is a complex decision that must take into account many variables including the type, location, and severity of the fractures, as well as the expectations of the patient. In some situations, metal implants may have to be removed at a later date.

Intramedullary (IM) rodding is a surgical procedure to stabilize a broken bone by inserting a metal rod in the hollow medullary canal of the bone. This part of the bone (where the bone marrow is) can be used to hold the rod and allow for early movement and weight-bearing in some cases

IM rodding can be utilized for fractures of the lower extremity long bones that are not close to the joints (bone ends). While this treatment can often allow for early movement, how soon one can resume walking after surgery often depends on the fracture type.

Proper treatment can help move you along with your recovery to ensure a good outcome. While fracture healing often seems slow, there are steps to ensure your healing of a broken bone. Make sure you follow your healthcare provider's instructions so that your broken bone will heal well!

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Stockman J. The Most Frequent Traumatic Orthopaedic Injuries From a National Pediatric Inpatient Population. Yearbook of Pediatrics. 2006;2006:326-327. doi:10.1016/s0084-3954(07)70197-5

Delft EAV, Gelder TGV, Vries RD, Vermeulen J, Bloemers FW. Duration of Cast Immobilization in Distal Radial Fractures: A Systematic Review. Journal of Wrist Surgery. 2019;08(05):430-438. doi:10.1055/s-0039-1683433

Migita RT, Klein EJ, Garrison MM. Sedation and Analgesia for Pediatric Fracture Reduction in the Emergency Department. Archives of Pediatrics & Adolescent Medicine. 2006;160(1):46. doi:10.1001/archpedi.160.1.46

Yip D, Chan C, Chiu P, Wong J, Kong J. Why are we still using pre-operative skin traction for hip fractures? International Orthopaedics. 2002;26(6):361-364. doi:10.1007/s00264-002-0387-8

Foster K. A brief review of the effects of preoperative skin traction on hip fractures. Journal of Orthopaedic Nursing. 2006;10(3):138-143. doi:10.1016/j.joon.2006.06.002

Marchese J, Wolf JM. Closed Reduction and Percutaneous Pinning of Metacarpal Fractures. Case Competencies in Orthopaedic Surgery. 2017:335-342. doi:10.1016/b978-0-323-39038-5.00035-4

Bible JE, Mir HR. External Fixation. Journal of the American Academy of Orthopaedic Surgeons. 2015;23(11):683-690. doi:10.5435/jaaos-d-14-00281

Matson AP, Barchick SR, Adams SB. Comparison of Open Reduction and Internal Fixation Versus Closed Reduction and Percutaneous Fixation for Medial Malleolus Fractures. JAAOS: Global Research and Reviews. 2017;1(8). doi:10.5435/jaaosglobal-d-17-00048

Yang L, Sun Y, Li G. Comparison of suprapatellar and infrapatellar intramedullary nailing for tibial shaft fractures: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2018;13(1). doi:10.1186/s13018-018-0846-6

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