What is the ultimate goal of fracture treatment?

“Dr. Sun, I’m here for another review!” When the old lady saw me, she ran over to me excitedly, as friendly as family. I also hurriedly greeted her and greeted her to come in and sit down. This was a patient I operated on six months ago, with a distal radius comminuted fracture. At that time, she was full of doubts and anxiety about the surgery! As a clinical doctor, I could understand the patient’s fear and uncertainty about surgery. After a long talk with her, she finally opted for surgery to treat her fracture. I took X-rays of her surgical site for this review. Six months after the surgery, the radius fracture is healing well and the internal fixation plate is in an ideal position. Checking the function of her wrist joint, she was really satisfied (as shown in the picture). When I told her that she had a good recovery after surgery, the old lady smiled happily and gave me a thumbs up!  The old lady went home satisfied, but I was in a long pensive mood. What is the end point of fracture treatment? As an orthopedic surgeon, what is the goal of our treatment of traumatic fractures? I kept asking myself this question! Is it the end of treatment for a patient with a fracture that we set the fracture, put an internal fixation on it and have a kind of beautiful postoperative piece? The answer I give is no! Why? Because, orthopedic diseases have their own special characteristics, different from other diseases of other departments. Fracture is a disease that concerns the function of the patient’s limbs. If the fracture is only fixed, but the function of the limb is not restored and the joint cannot move after surgery, this surgery is equal to nothing and the treatment is equal to zero! Therefore, the ultimate goal of fracture surgery should be to restore the function of the affected limb, not just a satisfactory post-operative film! Only when the post-operative function is satisfactory can the fracture treatment be considered a successful conclusion! The dilemma we are facing now is that there is a general relative shortage of beds in large hospitals and a relatively large number of patients. After surgery, patients are usually discharged home earlier without special circumstances. The patient is discharged from the hospital, from both the doctor and the patient are likely to neglect the rehabilitation exercise, so that the continuity of treatment is interrupted, which ultimately affects the effectiveness of treatment. Often patients will say to me, “Dr. Sun, can I come to the hospital a few times less, home is too far, and the hospital visits are too much trouble ……!” This mentality is common, and the result naturally speaks for itself.  I remember some time ago, the director of orthopedics in a hospital told me a story. The patient was a patella fracture and the surgery was done beautifully. The fracture was well reset, and the internal fixation position was satisfactory. However, six months after the surgery, the patient still could not squat completely. The patient himself thought that it was a normal post-operative sequelae, but he did not know that the fundamental problem was that post-operative rehabilitation and functional exercise were not enough. This example reawakened my thinking about the goal of fracture treatment. I think this goal needs to be accomplished in several stages: the first stage, surgery, and the second stage, postoperative functional rehabilitation. And, of course, for elderly fracture patients, there needs to be a third stage, long-term osteoporosis treatment to prevent re-fracture! Here again, I have to mention the goal of osteoporosis treatment: Stop at one! To achieve the ultimate goal of fracture treatment, mutual cooperation and joint efforts between the doctor and the patient are needed. The orthopedic surgeon should pay attention to the rehabilitation exercises after the surgery, demonstrate and supervise the patient, and supervise the review of the patient. In turn, the patient’s compliance should be high, and he or she should not have the psychology of fearing to seek medical treatment, not to mention the trouble of going to the hospital for review. Only in this way can we obtain the most satisfactory results!  Surgery and rehabilitation of fractures are like the two ends of a scale, the scale is perfect when it is balanced!