From the Research
The primary care physician (PCP) follow-up for a patient with a broken screw identified on X-ray should include an immediate referral to the orthopedic surgeon who performed the original hardware placement, as this approach is associated with improved patient outcomes and reduced morbidity, as suggested by the importance of follow-up care in studies such as 1. The PCP should contact the orthopedic surgeon's office directly to arrange an urgent appointment, typically within 1-2 weeks depending on the patient's symptoms and the location of the broken hardware. During the PCP visit, the physician should:
- Assess for signs of infection (redness, warmth, drainage)
- Evaluate pain levels using a standardized scale
- Check for any loss of function or mobility
- Determine if there is any visible deformity Pain management may include NSAIDs such as ibuprofen 600mg every 6 hours or naproxen 500mg twice daily, with acetaminophen 1000mg every 6 hours as needed for breakthrough pain, as supported by studies on pain management like 2. The PCP should advise the patient to limit weight-bearing or movement of the affected area as appropriate for the specific fracture location. Hardware failure can lead to loss of fracture stability, non-union, or malunion of the original fracture, which is why prompt orthopedic evaluation is essential. The orthopedic surgeon will determine whether revision surgery is necessary based on the fracture healing status, hardware position, and patient symptoms. Effective communication and follow-up are crucial, as highlighted in studies on radiology reporting and primary care physician perspectives, such as 3 and 4, to ensure that patient care is coordinated and that recommendations are acted upon in a timely manner.