Fracture Care in Primary Practice – What Can GPs Manage?

In general practice, GPs assess and manage a significant number of fractures—over 10% of all such injuries present initially in primary care (sportmedschool.com). This guide outlines when to immobilise and manage a fracture, when to refer, how to interpret X-rays, monitor healing and plan follow‑up. Let’s dive in.

1. Assessment & Initial Management

History & Examination

• Ask about injury mechanism, pain onset, swelling, deformity.
• Examine for neurovascular function: distal pulses, capillary refill, sensation, movement.
• Significant bruising, nailbed damage, open wounds or asymmetry = urgent referral (racgp.org.au, rch.org.au).

Indications for X‑Rays

Use Ottawa rules for knees and ankles; they’re highly sensitive and can help avoid unnecessary imaging (racgp.org.au).

Always order X‑rays for:

• Visible deformity
• Swelling + inability to weight-bear
• Significant point tenderness

Immediate Immobilisation

If grossly displaced, gently realign (reduce), assess neurovascular status pre- and post-realignment, then immobilise in a padded splint (emedicine.medscape.com, pmc.ncbi.nlm.nih.gov).

For example, humeral supracondylar fractures should be immobilised ~30° from full extension before X‑ray (rch.org.au).

2. Immobilise vs. Refer

Fractures GPs Can Manage

• Simple, non-displaced fractures of wrist, clavicle, distal radius.
• Buckle (torus) or greenstick in children.
• Selected undisplaced ankle or toe fractures.

Fractures Needing Referral

Refer directly if:

• Open fractures
• Neurovascular compromise
• Displaced/angulated fractures requiring reduction
• Multi-fragmentary or intra–articular involvement
• Supracondylar humerus fractures in children
• High-risk sites (e.g. femoral neck stress fracture, scaphoid if suspected) (sportmedschool.com, northeasthealth.org.au, emedicine.medscape.com).

Referral Pathways

• Emergency referral for open, displaced, neurovascular–compromised fractures.
• Urgent fracture‑clinic referral (within ~2 weeks) for displaced or potentially unstable fractures (northeasthealth.org.au, ncbi.nlm.nih.gov).

3. Interpreting X‑Rays

Use a systematic ABCS approach (geekymedics.com):

1. Alignment: check axis, joint spacing, look for dislocations.
2. Bone texture: assess for cortical interruptions or unusual lucencies.
3. Cortices: follow contours for breaks, assess displacement/angulation.
4. Soft‑tissue signs: look for fat‑pad signs or swelling.

Always get at least two orthogonal views—“one view is no view” (geekymedics.com).

Scaphoid fractures can be occult—initial X‑rays may miss them. If clinically suspected, immobilise in a thumb spica, then review or refer for MRI or CT at 10–14 days ().

4. Monitoring Healing & Follow-Up

Non-surgical cases:

• Re‑image only if clinically required. For distal radius fractures, repeat X‑ray isn’t routinely required when removing immobilisation (emedicine.medscape.com, pmc.ncbi.nlm.nih.gov).
• Follow-up intervals:
• Clavicle/proximal humerus ~3 weeks
• Lower‑limb fractures or displaced injuries ~6 weeks (racgp.org.au, northeasthealth.org.au).

Monitor for red flags:

• Persistent pain, swelling, deformity
• Signs of compartment syndrome, infection
• Delayed union or malunion presenting as pain or altered function

5. Post‑Fracture Care

Pain & Analgesia

• Adequate analgesia: paracetamol, NSAIDs. Use opiates short-term if needed.
• Encourage early movement of unaffected joints to prevent stiffness (emedicine.medscape.com, pmc.ncbi.nlm.nih.gov, radiologymasterclass.co.uk, racgp.org.au).

Rehabilitation

• Begin physiotherapy once healing is stable.
• Gradual return to weight-bearing and full function over weeks to months.

Preventing Complications

• Educate on signs of infection, DVT, malunion.
• Adults with fragility fractures need bone health screening (calcium, vitamin D, osteoporosis risk).

FAQs

Q: When should a GP re‑X‑ray after immobilisation?

Routine X‑rays aren’t needed unless symptoms change. One follow‑up image at 3–6 weeks is usually sufficient (emedicine.medscape.com).

Q: Suspected scaphoid fracture, negative X‑ray—what now?

Treat as fracture: immobilise in thumb-spica, review clinically in 10–14 days or arrange advanced imaging (MRI/CT) (northeasthealth.org.au).

Q: What indicates urgent referral?

Open fractures, significant displacement, neuro‑vascular compromise, joint involvement, or suspected compartment syndrome.

Q: How do Ottawa knee rules help?

They guide imaging decisions: age ≥ 55, fibula head/isolated patella tenderness, inability to flex to 90°, weight‑bearing inability—all high‑sensitivity criteria (emedicine.medscape.com, racgp.org.au).

Q: How often to monitor healing?

Typically check at 3 weeks (upper‑limb) or 6 weeks (lower‑limb/femur). More frequent if repositioning was needed or healing seems delayed.

GPs are key to managing many uncomplicated fractures: immobilisation, pain relief, clinical and radiographic follow‑up, and timely referral when needed. Structured X‑ray review and awareness of red‑flag features ensure optimal patient safety and outcomes. When in doubt, early consultation keeps patients well‑served.