Trauma & Fracture Management
Most fractures heal well with the right treatment, and a good number need no operation at all. The fractures that cause lasting trouble are the ones where alignment was accepted as close enough, where a joint surface was left uneven, or where healing quietly failed and was not picked up. Getting the first decision right is what prevents the difficult second operation.
- Complex Intra-articular Fractures
- Pelvic & Acetabular Trauma
- Malunion & Nonunion Correction
- Polytrauma Care
What makes a fracture "complex"?
Several features move a fracture out of the routine category: the break extends into a joint surface, the bone is broken into multiple fragments, the fracture is open (the skin is breached, which introduces infection risk), the fracture is accompanied by injury to nerves or blood vessels, or the bone is weakened by osteoporosis or previous disease. Complex fractures need planning — often CT imaging to understand the fragment pattern before deciding on the approach and the implant.
When does a fracture need surgery?
A fracture is treated without surgery when the fragments are in acceptable position and can be held there reliably in a cast or brace while healing proceeds. Surgery is indicated when the fragments are displaced and will not stay reduced, when the fracture involves a joint surface, when the fracture is unstable, when it is open, or when early movement is essential to a good outcome — as it often is around the elbow and shoulder. Fixation is not about the bone alone; it is about restoring the function that depends on that bone.
Intra-articular fractures: why alignment matters
When a fracture runs into a joint, the cartilage surface is broken as well as the bone. Cartilage does not regenerate, and a step or gap left in that surface concentrates load in a way the joint was never designed to tolerate. Over years this reliably produces post-traumatic arthritis. This is why intra-articular fractures — around the ankle, knee, elbow, wrist and shoulder — are reconstructed with far tighter tolerances than shaft fractures, often with CT planning and anatomical fixation.
Pelvic and acetabular trauma
Pelvic fractures usually follow high-energy injury and can be life-threatening in the early hours because of the bleeding associated with them, which is why initial management is a resuscitation priority. Acetabular fractures involve the socket of the hip joint and are among the most technically demanding fractures to reconstruct, requiring detailed CT assessment and careful surgical planning. Restoring the socket accurately is what preserves the hip, and it also makes any later hip replacement considerably more straightforward.
When a fracture fails to heal
A malunion is a fracture that healed in a poor position; a nonunion is one that has not healed at all. Both are treatable, and both are worth acting on rather than accepting. Signs of a nonunion include continuing pain at the fracture site months after injury, persistent tenderness, movement at the site, or an X-ray that shows no progression of healing. Contributing factors include smoking, poor blood supply at the fracture, infection, inadequate stability, diabetes and poor nutrition — several of which can be corrected as part of treatment. Correction generally involves re-establishing stability and, where needed, bone grafting to restart the biological healing process.
Polytrauma: priorities in the first hours
When someone has multiple injuries, orthopaedic fixation takes its place within a wider sequence. Life-threatening problems are addressed first, major fractures are stabilised early to reduce bleeding and pain and to allow the patient to be moved and nursed safely, and definitive reconstruction follows once the patient is physiologically stable. Coordinating that sequence properly is what determines both survival and the eventual functional result.
Frequently Asked Questions
Does every fracture need surgery?
No. Many fractures heal well in a cast or brace when the fragments are in acceptable position and stay there. Surgery is needed when fragments are displaced and unstable, when the fracture involves a joint surface, when it is open, or when early movement is important to the final result — as it often is around the elbow and shoulder.
How long does a fracture take to heal?
Most adult fractures unite in roughly six to twelve weeks, though this varies considerably with the bone involved, the pattern of the fracture, your age and your general health. Returning to full function usually takes longer than the bone takes to heal, because strength and joint movement have to be rebuilt afterwards.
What is a nonunion, and can it be fixed?
A nonunion is a fracture that has failed to heal. Suggestive signs are ongoing pain and tenderness at the site months after injury and X-rays showing no progression. It is treatable — usually by re-establishing stable fixation and, where the biology is the problem, adding bone graft. Contributing factors such as smoking, infection or poor nutrition are addressed alongside.
Why do some fractures need a plate and others a rod?
The choice depends on the bone and the fracture pattern. Plates and screws hold fragments in precise anatomical position, which matters most for fractures involving joint surfaces. Intramedullary rods sit inside the shaft of long bones like the femur and tibia, share load with the bone and often allow earlier weight-bearing. Each suits different situations.
Why does a fracture that has healed still hurt?
Common reasons include stiffness and weakness in the surrounding muscles and joints, irritation from the implant itself, nerve irritation, or post-traumatic arthritis if the fracture involved a joint surface. Persistent pain months after a fracture has united is worth assessing rather than accepting, since several of these causes are treatable.
Read more on how fractures heal and when surgery is needed or ankle sprain vs. fracture. See trauma & fracture surgery with Dr. Ghag, or book a consultation.