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Introduction To Office Fracture Management
Introduction To Office Fracture Management
Robert L. Kalb
Primary care physicians are able to treat a wide range of fractures in the office and obtain good clinical outcomes. Your level of training and knowledge indicates the complexity of the fractures that you can treat. This chapter discusses the elements of strong fracture management skills: education, training, case selection, and orthopedic consultations. As a quick reference, insurance codes and billing information for fracture treatments are presented.
EDUCATION AND TRAINING
Fracture management training can be done through course work and preceptorships. This handbook serves as an important tool for reference and can be used as a guide for fracture evaluation and treatment during residency and in practice. The author also can recommend additional courses and arrange preceptorships.
Courses
The National Procedures Institute in Midland, Michigan (www.npinstitute.com), offers fracture courses directed toward primary care. Jack Pfenninger, a family physician, founded the institute, which has an outstanding reputation for teaching procedure skills. Course work includes workshops on cast and splint applications, x-ray review, and decision making in fracture management.
Preceptorship
A preceptorship with an orthopedic surgeon is an excellent way to obtain training. You should decide beforehand how much time you can devote toward training and the complexity of fracture management that you want to learn. To arrange a preceptorship, contact Robert L. Kalb, MD, (419) 472-3791, 3900 Sunforest Ct, Suite 119, Toledo, OH 43623.
CASE SELECTION
You should master simple cases of fracture management before you progress to cases with higher degrees of difficulty. Simple fractures are extraarticular, nondisplaced, and nonangulated. Complex fractures extend into the joint (intraarticular) or are displaced and angulated, possibly requiring reduction.
Fracture management for children and adults differs greatly. Children’s fractures will be presented separately in this handbook. Case presentations include treatment options and variations, frequency of office follow-up visits, and pitfalls in fracture management. Fracture characteristics are discussed, such as appearance and force involved with the trauma causing the fracture. For example, fractures associated with motor vehicle accidents have more soft tissue damage and a greater chance for complications, such as nerve or vessel injury and compartment syndrome, than those fractures that occur from a fall in standing position at ground level.
