This third edition of Fracture Management for Primary Care, published 8 years after the second, has been significantly enhanced while maintaining its basic framework. With the continuing need for primary care physicians to assume the central role in the contemporary and anticipated models of health care delivery, this book is an excellent and timely addition.
The authors lay out the context within which evaluation and management of fractures occur in the primary care setting based on their review of published studies.1- 5 Based on the authors' analysis of the National Ambulatory Medical Care Survey, fractures and dislocations made up 1.2% of all visits and ranked 18th in the top 20 diagnoses. Sixty-eight percent of patients with fractures were seen by orthopedic surgeons, 10% by family physicians, and the rest by pediatricians and internists. In patients younger than 17 years, fracture care was provided by orthopedic surgeons in 65%, by pediatricians in 17%, and by family physicians in 6%. A few studies provide data on the type and distribution of fractures seen in different practice settings. The fractures most commonly reported affect the fingers, radius, metacarpals, toes, and fibula. Another study reported the top 5 fracture sites to be the distal radius, metacarpal, proximal femur, finger, and ankle. In general, when or if a patient is referred to an orthopedic surgeon, the referral varies depending on the practice setting, availability of an orthopedic surgeon, and personal experience of the primary care physician in the management of fractures. With experienced family physicians the referral rate is reported to be between 16% and 25% of fractures. The most common reasons for referral include angulated or displaced fractures, multiple fractures, intra-articular fractures, fracture-associated nerve or tendon injury, or epiphyseal plate injury. Most uncomplicated fractures treated in the primary care setting show good outcome in terms of healing and function.