Treating patients with a fracture: Engage an expert

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Working with an expert is essential when healthcare professionals are faced with an injury, condition, or ailment that is outside of their expertise.
Working with an expert is essential when healthcare professionals are faced with an injury, condition, or ailment that is outside of their expertise.

Partnership is imperative, especially in a field like ours. As healthcare professionals, we work hard to bring the best care we can to our patients, but we are frequently faced with an injury, condition, or ailment that is outside of our expertise. This is when collaboration becomes even more essential. As a foot and ankle surgeon, it's important for me to partner with healthcare professionals from all specialty areas, and one of my most important collaborations is with NPs. In fact, the 2 NPs in my practice are invaluable resources for me and I regularly look to them for their expertise and guidance.

I practice in Champaign, Illinois and during our beautiful Midwest summer months, the number of lower-extremity fractures I see takes a significant increase. When the weather begins to warm up, activities like running, basketball and volleyball also pick up. As more patients begin to present with sports-related fractures, collaboration is the first step toward their proper diagnosis and timely recovery.

Watch for these conditions

When deciding whether or not to call in an expert on a particular fracture case, there are important signs to look for. If a patient presents with a fracture specific to the foot or ankle, there are 4 key points to examine:

  • Displacement of the fracture
  • Intra-articular or joint involvement
  • Location of the fracture
  • Surrounding soft tissue structure 

If concern arises based on the assessment of these 4 indicators, a foot and ankle surgeon should be consulted immediately. Technological advances have helped expedite the process for foot and ankle surgeons to provide a consultation in the emergency room/urgent care setting and determine whether surgical fixation is needed or if the fracture can be treated conservatively. 

Engage an expert

When a patient presents with an injury symptomatic of a sprain or fracture, bringing in a foot and ankle surgeon can help the healthcare team determine the most appropriate course of action, especially if there is any doubt after looking at an X-ray. This will also help the team avoid setting false expectations and avoid unnecessary treatments. For instance, what may look like a fracture that requires surgery could, in fact, be a case that is best revisited after a period of recovery to determine the best course of treatment. 

Pediatric fractures are a great example of an injury that may need a second, later consultation. Young bones, joints and ligaments are still developing, and a fracture on a growth plate may not show up on an X-ray. A foot and ankle surgeon can determine whether the injury is indeed a fracture and, if so, recommend the best treatment plan with consideration to pain and swelling.

Because the foot and ankle is a complex extremity, it's incredibly important to bring in an expert when a patient presents with an injury below the knee. Just as not all fractures are detectable on X-rays, some fractures that look stable could actually require surgical intervention.  For example, a fracture to the distal fibula on the outside of the ankle can appear to be treatable with conservative action. But there may be ligament disruption that is undetectable on X-ray and requires surgical fixation. This is a case when a typically difficult diagnosis is made easier with the assistance of a foot and ankle surgeon.

Collaboration is key

This kind of collaboration is very much a 2-way street. Every day I am reminded how important my relationships with NPs are to our patients and our practice. For those foot and ankle cases where surgery is not required, I turn to the expertise of the NPs I work with to provide the care our patients need throughout the healing process. There are also those cases when NPs, because of their strong clinical insight, can identify undetected conditions. For example, I recently saw a patient who injured his foot playing basketball. His X-rays came back normal and the case didn't appear too complex. However, the NP drew on her clinical experience, thinking the patient might have a Lisfranc fracture. She appropriately ordered weight-bearing X-rays on both sides of the foot which confirmed that it was indeed a Lisfranc fracture that required surgery. Thanks to the NP's experience and intuition, the patient received the necessary care and could get back to functioning as quickly as possible.

Partners in care

I'm extremely grateful for the partnerships I have developed with NPs throughout my career. We work together every day as part of the multidisciplinary care team to ensure patients receive the most accurate, timely and comprehensive care possible. Developing and cultivating these collaborative-care relationships is essential to our practices and should be a priority for all medical professionals, no matter their specialty. The American College of Foot and Ankle Surgeons' “Take a New Look” campaign is one way NPs can learn more about our expertise and when we can best assist their patients. With more education and training specific to the foot and ankle than any other healthcare provider, foot and ankle surgeons are your dedicated partners in care.

Sean Grambart, DPM, FACFAS, is a foot and ankle surgeon at the Carle Physician Group, Department of Surgery, in Champaign, Illinois and at Kirby Hospital in Monticello, Illinois.

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