Upper and Lower Limb Fractures
A fracture is a break in a bone. It can be a hairline crack that is barely visible on X-ray, a clean break that has stayed in position, or a bone in several pieces with the joint surface involved. “Broken” and “fractured” mean the same thing — one is not more serious than the other.
What decides treatment is not the name of the injury but three questions: is the bone still lined up, will it stay lined up, and does the break run into a joint? Dr Janan Chandrananth manages fractures of the arm and the leg, from the emergency department through to the end of rehabilitation.
Fractures Dr Janan treats
Dr Janan treats fractures across the upper and lower limb in adults of all ages.
Lower limb:
Femur (thigh bone) fractures, including fractures around the hip
Fractures around the knee — the kneecap (patella), the lower femur and the tibial plateau
Tibia and fibula (shin) fractures
Ankle fractures and pilon fractures of the weight-bearing surface above the ankle
Foot fractures — the heel bone (calcaneus), talus, Lisfranc midfoot injuries, metatarsals and toes
Upper limb:
Collarbone (clavicle) and shoulder fractures, including the top of the humerus
Humerus (upper arm) fractures
Elbow fractures — the olecranon, radial head and lower humerus
Forearm fractures
Wrist fractures, including the distal radius and scaphoid
Hand and finger (metacarpal and phalangeal) fractures
Stress fractures — small cracks from repeated loading rather than a single injury, most often in the foot and shin — are treated as well. Children’s fractures are covered on a separate page, as are ligament and tendon injuries.
Signs a bone may be broken
A fracture and a bad sprain can feel very similar in the first few hours. The features that make a fracture more likely are:
Pain that is worst directly over the bone, rather than the soft tissue beside it
Being unable to put weight through the leg, or to use the arm, beyond a few steps or movements
Swelling and bruising that come on quickly
A limb that looks bent, shortened or out of shape
A grinding sensation, or a snap heard at the time of injury
None of these is proof on its own, and none rules a fracture out. An X-ray is the only reliable way to tell, which is why an injury with any of these features should be imaged rather than waited out. What’s the difference between a sprain and a fracture?
Diagnosis
X-ray — the first investigation for almost every suspected fracture. It shows the break, the alignment and, with weight-bearing views, whether the joint is stable.
CT — used where the fracture involves a joint surface or the pattern is complex. It shows the fragments in three dimensions and is how most fracture surgery is planned.
MRI — for fractures that do not show on X-ray, such as stress fractures, and where a ligament or cartilage injury is suspected alongside the break.
Treatment without surgery
Most fractures do not need an operation. Where the bone is in acceptable alignment and is likely to stay there, treatment is protection — a cast, a splint or a walking boot — while the bone heals in position. What that protection looks like, how long it lasts and how much weight you can put through the limb depend on the bone involved.
Non-surgical treatment still needs close follow-up. Fractures can shift in the first two to three weeks, so repeat X-rays are taken to confirm the position is holding.
When surgery is recommended
Surgery is recommended where a fracture cannot be held in an acceptable position without it, or where the cost of a cast — months of immobilisation — outweighs the risks of an operation. Common reasons include:
The bone fragments are displaced and a cast cannot hold them in place
The fracture is unstable, or the joint it belongs to is unstable
The break runs into a joint surface, where even a small step can lead to arthritis
The bone has come through the skin (an open fracture), which needs urgent surgery to clean the wound
More than one bone or limb is injured, and early fixation lets you get moving
The aim is to put the bone back in position and hold it there while it heals — with plates and screws, a rod (intramedullary nail) down the centre of a long bone, or occasionally an external frame. Fixation also allows earlier movement of the joints nearby, which reduces stiffness. Do all fractures need surgery? If the break is in the leg, what’s involved in surgery for a broken leg walks through the operation and what follows it.
Healing and recovery
Bone heals in stages. Most fractures reach the point where they can take load in six to twelve weeks — a wrist fracture is usually out of its cast at six weeks — though the larger bones of the leg, the tibia and femur, commonly take three to six months to heal fully. Rehabilitation runs alongside: restoring movement, then strength, then the specific demands of your work or sport. Will I need physiotherapy after fracture surgery?
Healing is slower in smokers, in people with diabetes or poor nutrition, and where the blood supply to the bone is limited. Increasing pain, a limb that still cannot take weight when it should, or a fracture that looks unchanged on serial X-rays are the signs to watch for. What are the warning signs a fracture isn’t healing properly?
Dr Janan’s approach
Dr Janan Chandrananth is an Australian-trained orthopaedic surgeon who manages the full spectrum of orthopaedic trauma in the upper and lower limb. He is a visiting medical officer at Frankston Hospital, where he treats the whole range of adult fractures and supervises orthopaedic trainees. He also completed fellowship training in foot and ankle surgery in Bristol and in Tokyo, which matters most for fractures that involve a joint surface — at the ankle, the knee or the wrist — where the accuracy of the reconstruction decides how the joint works for years afterwards.
Privately, he operates at St John of God Berwick and Mulgrave Private, with consulting rooms in Mulgrave and Berwick. Urgent injuries are prioritised.
Broken a bone, or been told you have a fracture?
Book a consultation with Dr Janan Chandrananth to have the injury assessed and a treatment plan made. Urgent cases are prioritised.
Request an Appointment
FAQs
I have already been seen in an emergency department. Do I still need to see an orthopaedic surgeon?
Usually, yes. Emergency departments stabilise the injury in a temporary splint or cast; the decision about definitive treatment — cast or surgery, and for how long — is made at orthopaedic follow-up. Bring your imaging and a referral letter from the emergency department doctor or your GP — a discharge summary alone is not a referral. Our private fracture clinic sees urgent fractures within two business days.
Can a fracture heal without surgery?
Most do. Where the bone is well aligned and stable, a cast or boot lets it heal in position. Surgery is for fractures that are displaced, unstable, open, or through a joint surface — the ones that would heal in the wrong place if left alone.
How long does a broken bone take to heal?
Six to twelve weeks for most fractures to unite enough to take load — longer for the tibia and femur, shorter in children. Full recovery takes longer than the bone itself: strength, confidence and return to sport or heavy work commonly take three to six months, and up to a year after major lower limb injuries.
Will I be in a cast or a boot?
A cast holds the bone more rigidly and cannot be removed; a boot can be taken off for washing and, once permitted, for exercises. Which is right depends on how stable the fracture is. Many start in a cast and move to a boot as healing progresses.
Will the plates and screws need to come out?
Usually not. Metalwork is generally left in permanently. It is removed if it is prominent and irritating — most often over the outer ankle and the collarbone, where there is little soft tissue over the bone — and occasionally in younger patients, once the fracture has healed.
Do I need a referral?
A referral from a GP or hospital doctor is needed to claim the Medicare rebate on your consultation. If you were seen in an emergency department, ask the treating doctor for a referral letter before you leave; the discharge summary on its own is not one. If you do not have one, call the rooms on (03) 9123 4402 and reception will explain your options.