Non-Surgical Management Options for Patients with Fractures
For patients who prefer to avoid surgery, non-surgical management options including casting, splinting, rehabilitation, and pain management can be effective for many fracture types, particularly those that are minimally displaced or stable.
Fracture-Specific Non-Surgical Options
Distal Radius Fractures
- Rigid immobilization is recommended over removable splints for displaced distal radius fractures 1
- Removable splints are an option for minimally displaced distal radius fractures 1
- Early finger motion is essential during immobilization to prevent edema and stiffness 1
- When immobilization is discontinued, aggressive finger and hand motion is necessary for optimal outcomes 1
Clavicle Fractures
- Non-surgical management is appropriate for minimally displaced clavicle fractures with low nonunion rates 1
- For displaced clavicle fractures, non-surgical treatment remains a valid option, though it may result in:
- Higher rates of nonunion (up to 15%)
- Possible symptomatic malunion
- Longer time to union compared to surgical treatment 1
Humeral Fractures
- Both non-surgical and surgical treatment can be considered for metastatic humeral disease 1
- For proximal humeral fractures (especially in elderly patients), short-term immobilization followed by early physical therapy is a viable option 2
Rehabilitation Components
Early Post-Fracture Phase
- Implement appropriate rehabilitation program consisting of:
- Early post-fracture introduction of physical training
- Muscle strengthening exercises
- Balance training
- Multidimensional fall prevention 1
Long-Term Rehabilitation
- Continue with:
- Progressive physical training
- Functional mobility exercises
- Balance training to prevent future falls 3
- Early identification of individual goals and needs is essential before developing the rehabilitation plan 1
Pain Management
- Limit opioid use to breakthrough pain only 3
- Consider non-opioid analgesics as first-line treatment
Bone Health Optimization
- Ensure adequate calcium (1000-1200 mg/day) and vitamin D (800 IU/day) supplementation 3
- Consider anti-osteoporosis medication for elderly patients with fragility fractures 3
Fall Prevention
- Implement multidimensional fall prevention strategies:
- Home safety assessment
- Appropriate use of assistive devices
- Proper footwear
- Adequate lighting 3
Important Considerations and Pitfalls
When Non-Surgical Management May Not Be Optimal
- Widely displaced fractures have higher risk of:
- Nonunion
- Symptomatic malunion
- Adverse effects on strength and function 1
- Cosmetic concerns
Patient Education
- Patients should be educated about:
- Expected timeline for healing
- Signs of complications requiring medical attention
- Importance of compliance with immobilization
- Proper use of assistive devices 3
Monitoring
- Regular radiographic evaluation for at least 3 weeks and at cessation of immobilization for distal radius fractures 1
- Regular follow-up appointments to monitor healing progress and adjust treatment plan as needed 3
Special Considerations for Elderly Patients
- Elderly patients with hip fractures require comprehensive rehabilitation to regain pre-fracture mobility and independence 1
- Consider co-management with geriatric specialists for frail elderly patients with multiple comorbidities 1
- Be aware that mortality 5 years after hip or vertebral fracture is about 20% higher than expected, with highest risk in men >75 years with chronic diseases 4
Non-surgical management remains a viable option for many fracture types, particularly when they are minimally displaced. However, patients should understand the potential trade-offs including possibly longer healing time, higher risk of nonunion in certain fracture patterns, and the importance of adherence to rehabilitation protocols for optimal outcomes.