What is the treatment for transverse fractures?

Treatment of Transverse Fractures

The treatment of transverse fractures requires a balanced approach between operative and non-operative management, with the specific treatment determined by fracture location, displacement, stability, and patient factors. 1

General Principles of Transverse Fracture Management

Non-displaced Fractures

• Cast immobilization is the primary treatment for non-displaced transverse fractures (displacement <2-3mm) 2
  • Typical immobilization period: 4-6 weeks depending on fracture location and healing progress
  • Rigid immobilization preferred over removable splints for better stability
  • Appropriate analgesics (NSAIDs if not contraindicated, minimal opioid use if necessary)

Displaced Fractures

• Initial attempt at closed reduction for displaced fractures 2
• If reduction achieves <2mm displacement → immobilize with rigid cast
• If residual displacement remains >2mm or closed reduction fails → consider surgical intervention with open reduction and internal fixation (ORIF)

Treatment by Specific Fracture Location

Transverse Acetabular Fractures

• Displaced transverse acetabular fractures typically require surgical repair 3
• Surgical technique may include:
  • Clamp-assisted reduction through sciatic notch
  • Anterior column screw fixation
  • Posterior column plating through Kocher-Langenbeck exposure
• Goal is anatomical reduction and stable fixation until union 3
• In complex cases, transformation of transverse fractures into T-shaped fractures may facilitate sequential reduction 4

Transverse Sacral Fractures

• High incidence of neurological impairment (97% of cases) ranging from radiculopathy to bowel-bladder disturbance 5
• Surgical treatment generally associated with better outcomes for stability and neurological recovery 5
• High vs. low transverse sacral fractures have different characteristics but share high incidence of cauda equina disturbance

Isolated Transverse Process Fractures

• Conservative management without neurosurgical or orthopedic consultation is appropriate 6
• These fractures are neurologically and structurally stable
• No bracing or surgical intervention required
• Important to evaluate for other associated spinal or abdominal injuries, which occur frequently

Proximal Phalanx Transverse Fractures

• In elderly osteoporotic patients, closed reduction and percutaneous "periarticular" single K-wire fixation can be effective 7
• Allows for immediate active mobilization of joints
• Can achieve excellent to good total active motion outcomes

Femoral Neck Fractures (Transverse Pattern)

• Stable non-displaced fractures: cannulated fixation in a percutaneous manner 1
• Displaced fractures in healthy, active older individuals: total hip replacement 1
• In frail patients: hemiarthroplasty may be preferred (shorter operative time, lower dislocation risk) 1

Rehabilitation and Follow-up

• Begin gentle passive range of motion exercises at approximately 4 weeks 2
• Progress to active-assisted range of motion as tolerated
• Advance to strengthening exercises after fracture healing is evident
• Clinical and radiographic follow-up at 2-week intervals initially 2
• Regular monitoring for at least 6 months to assess:
  • Pain levels
  • Range of motion progress
  • Fracture healing
  • Functional improvement
  • Potential complications (e.g., premature physeal closure)

Prevention of Subsequent Fractures

• Each patient aged 50+ with a recent fracture should be evaluated for subsequent fracture risk 1
• Consider enrollment in a Fracture Liaison Service for systematic evaluation 1, 2
• Calcium (1000-1200 mg/day) and vitamin D (800 IU/day) supplementation recommended 2
• Fall prevention strategies and bone health assessment as appropriate

Common Pitfalls and Caveats

• Failure to recognize associated injuries, particularly with transverse process fractures 6
• Inadequate immobilization period leading to delayed union or non-union
• Overlooking neurological deficits, especially in transverse sacral fractures 5
• Insufficient follow-up to detect complications such as malunion or premature physeal closure 2
• Underestimating the importance of early mobilization and rehabilitation in functional outcomes