Fracture Protocol Quick Reference

These protocols are intended as a practical reference and do not replace patient-specific clinical judgment. Management may vary based on fracture pattern, stability, soft-tissue condition, age, comorbidities, associated injuries, fixation method, and radiographic healing.

Protocol Reference Table

Click any row for motion, follow-up/imaging, hardware removal, and clinical notes.

	Injury	Body Region	Initial Immobilization	Weight-Bearing / Limb Use
	Buckle (Torus) Fracture of the Distal Radius Pediatric Nonoperative	Wrist and Hand	A short-arm splint, typically worn for about 3 weeks.	No weight bearing (limb use) through the arm for about 4 weeks.
Motion No resistance or strengthening (NRM) for about 4 weeks. Gentle, comfortable use of the fingers and hand is fine. Physical Therapy Usually none; home finger and wrist motion after splint removal if comfortable. Follow-Up / Imaging A 1-week alignment X-ray to confirm the bone is healing in a good position, then a 4-week X-ray to confirm healing and clear the weight-bearing restriction. Expected Bone Healing About 4 weeks. Return to Work / School School as tolerated in the splint; avoid lifting and playground falls until cleared. Return to Sports / High-Risk Activity Return after painless motion and use, usually about 4–6 weeks. Bone Doc Pearl A buckle fracture is stable and usually needs comfort and short protection—not repeated prolonged casting. Urgent Referral / Red Flags Unexpected deformity, increasing pain, numbness, color change, skin breakdown, or failure to resume use. Clinical Notes A buckle (torus) fracture is a stable, minor bend or buckle in the bone rather than a full break — one of the mildest and most common childhood wrist injuries. Full Patient Page Buckle (Torus) Fracture of the Distal Radius →
	Greenstick or Metaphyseal Fracture of the Distal Radius Pediatric Nonoperative	Wrist and Hand	A short-arm cast (SAC), typically worn for about 4 weeks.	No weight bearing (limb use) through the arm for about 6 weeks.
Motion No resistance or strengthening (NRM) for about 6 weeks. Physical Therapy Usually home motion after immobilization; formal therapy only for persistent stiffness. Follow-Up / Imaging Weekly alignment X-rays for the first 2 weeks to confirm the bone is healing in good position, then a 6-week X-ray to confirm healing and clear the weight-bearing restriction. Expected Bone Healing About 4–6 weeks. Return to Work / School School as tolerated with restrictions; no lifting or fall-risk activity until healing is confirmed. Return to Sports / High-Risk Activity Usually 6–8 weeks after painless motion and radiographic healing. Bone Doc Pearl Children remodel well, but early alignment checks matter because an incomplete fracture can still displace. Urgent Referral / Red Flags Loss of reduction, increasing deformity, neurovascular symptoms, compartment concern, or skin problems. Clinical Notes A greenstick fracture is a partial break where the bone bends and cracks on one side, similar to a green tree branch — common in growing bones because they are more flexible than adult bone. Full Patient Page Greenstick or Metaphyseal Fracture of the Distal Radius →
	Physeal (Growth Plate) Fracture of the Distal Radius Pediatric Nonoperative	Wrist and Hand	A short-arm cast (SAC) for about 4 weeks, then the cast is removed and the wrist is gently mobilized.	No weight bearing (limb use) through the arm for about 6 weeks.
Motion No resistance or strengthening (NRM) for about 6 weeks. Physical Therapy Usually not required initially; begin motion after immobilization if healing is satisfactory. Follow-Up / Imaging Weekly alignment X-rays for the first 3 weeks to confirm the bone is healing in good position. After that, your child's growth plate is monitored periodically (roughly every 3 months) until it's clear the growth plate is developing normally — this is sometimes tracked using markers on X-ray called Park-Harris lines. Expected Bone Healing About 4–6 weeks, with longer-term growth surveillance when indicated. Return to Work / School School as tolerated with protection; avoid lifting and fall-risk activity until cleared. Return to Sports / High-Risk Activity Usually 6–8 weeks, after painless motion and healing. Bone Doc Pearl Growth-plate injuries often heal quickly, but selected patterns deserve later surveillance for growth arrest. Urgent Referral / Red Flags Loss of reduction, worsening deformity, neurovascular symptoms, open injury, or later asymmetric growth. Clinical Notes This fracture involves the growth plate — the area of developing cartilage near the end of a child's bone. Growth plate injuries are watched extra closely because, in rare cases, they can affect how the bone continues to grow. This is why your child's surgeon may recommend follow-up over several months. Full Patient Page Physeal (Growth Plate) Fracture of the Distal Radius →
	Pediatric Galeazzi Fracture Pediatric Nonoperative	Elbow and Forearm	A long-arm cast (LAC), applied with the forearm turned palm-up (supination), for about 4 weeks.	No weight bearing (limb use) through the arm for about 6 weeks.
Motion No resistance or strengthening (NRM) for about 6 weeks. Physical Therapy Formal therapy is uncommon in younger children; use if forearm rotation remains limited after immobilization. Follow-Up / Imaging Weekly alignment X-rays for the first 2 weeks to confirm the bone is healing in good position, then a 6-week X-ray to confirm healing and clear the weight-bearing restriction. Expected Bone Healing About 6–8 weeks. Return to Work / School School with restrictions; no lifting, climbing, or contact activity until union and DRUJ stability. Return to Sports / High-Risk Activity Usually 8–12 weeks after painless forearm rotation and radiographic healing. Bone Doc Pearl Always reassess the distal radioulnar joint—the radius fracture is only half of the injury. Urgent Referral / Red Flags Loss of reduction, DRUJ instability, increasing pain, neurovascular symptoms, or compartment concern. Clinical Notes A Galeazzi fracture involves a break in the forearm bone (radius) along with an injury to the joint where the forearm bones meet the wrist. If your child develops new pain on the pinky side of the wrist, tell your surgeon — this can be a sign that the small cartilage cushion in the wrist (the TFCC) needs a closer look. Full Patient Page Pediatric Galeazzi Fracture →
	Pediatric Both-Bone Forearm Fracture (Age Under 10) Pediatric Nonoperative	Elbow and Forearm	A long-arm splint (LAS) for about 2 weeks, then a short-arm cast (SAC) for about 6 more weeks.	No weight bearing (limb use) through the arm for about 6–8 weeks.
Motion No resistance or strengthening (NRM) for about 8 weeks total. Physical Therapy Usually home motion after cast removal; therapy only if motion does not steadily return. Follow-Up / Imaging Weekly alignment X-rays for the first 3 weeks to confirm the bones are staying in a good position for your child's age, then a 6-week X-ray to confirm healing and clear the weight-bearing restriction. Expected Bone Healing About 6–8 weeks. Return to Work / School School as tolerated in cast; avoid lifting, wheels, climbing, and playground falls. Return to Sports / High-Risk Activity Usually 8–12 weeks; refracture precautions may extend longer. Bone Doc Pearl Young children remodel well, but the forearm remains vulnerable to refracture after the cast comes off. Urgent Referral / Red Flags Loss of alignment, increasing pain, numbness, swelling, compartment concern, or cast problems. Clinical Notes This describes a fracture of both forearm bones (radius and ulna) together. Because younger bones remodel and straighten as they grow, surgeons can accept slightly more angulation in younger children than in older children or adults — your surgeon will confirm whether your child's X-ray alignment is acceptable. Full Patient Page Pediatric Both-Bone Forearm Fracture (Age Under 10) →
	Pediatric Both-Bone Forearm Fracture (Age 10 and Older) Pediatric Nonoperative	Elbow and Forearm	A long-arm splint (LAS) for about 2 weeks, then a short-arm cast (SAC) for about 6 more weeks.	No weight bearing (limb use) through the arm for about 6 weeks.
Motion No resistance or strengthening (NRM) for about 8 weeks total. Physical Therapy Consider therapy if pronation/supination or elbow/wrist motion is slow to recover. Follow-Up / Imaging Weekly alignment X-rays for the first 3 weeks. Older children have less remaining growth to correct angulation, so your surgeon allows less angulation on X-ray than for a younger child with the same injury. A 6-week X-ray then confirms healing and clears the weight-bearing restriction. Expected Bone Healing About 8–10 weeks. Return to Work / School School with restrictions; no lifting or fall-risk activity until union. Return to Sports / High-Risk Activity Usually 10–14 weeks, with longer refracture precautions for high-risk activity. Bone Doc Pearl Older children have less remodeling potential, so alignment and rotation deserve closer attention. Urgent Referral / Red Flags Loss of reduction, rotational deformity, neurovascular symptoms, compartment concern, or delayed healing. Clinical Notes This describes a fracture of both forearm bones (radius and ulna) together in an older child or pre-teen, who has less remaining growth to naturally correct any residual angulation compared with a younger child. Full Patient Page Pediatric Both-Bone Forearm Fracture (Age 10 and Older) →
	Recovery After Elastic Nail Fixation of a Forearm Fracture Pediatric Operative	Elbow and Forearm	A long-arm splint (LAS) for about 3 weeks, then it is removed to begin elbow range-of-motion exercises.	No weight bearing (limb use) through the arm for about 6 weeks.
Motion No resistance or strengthening (NRM) for about 6 weeks. Elbow motion begins once the splint is removed, around 3 weeks. Physical Therapy Begin guided elbow, wrist, and forearm motion when permitted; formal therapy if motion lags. Follow-Up / Imaging An X-ray at 6 weeks to confirm healing and clear the weight-bearing restriction. A return visit around 4–6 months is planned for hardware removal, once your child's surgeon confirms healing (a bridging callus across all three visible sides of the bone on X-ray). Expected Bone Healing About 6–10 weeks. Return to Work / School School early with restrictions; no lifting, climbing, or contact activity until union. Return to Sports / High-Risk Activity Usually 10–14 weeks, after union and functional motion; protect against refracture. Hardware Removal The elastic nail (flexible rod placed inside the bone during surgery) is typically removed in a short outpatient surgery at 4–6 months, once X-rays confirm solid healing across all three cortices (sides) of the bone. Bone Doc Pearl Elastic nails stabilize the bone, but they do not make a healing forearm ready for early impact. Urgent Referral / Red Flags Infection, migration or prominence of nails, loss of motion, neurovascular symptoms, or delayed union. Clinical Notes An elastic (flexible) nail is a smooth, bendable metal rod placed inside the bone to hold a forearm fracture in good position while it heals. It is designed to be removed once healing is confirmed. Full Patient Page Recovery After Elastic Nail Fixation of a Forearm Fracture →
	Recovery After Elastic Nail Fixation of a Tibia Fracture Pediatric Operative	Leg and Ankle	A short-leg cast (SLC) or fracture (walking) boot.	No weight bearing (NWB) on the leg for about 4 weeks.
Motion No resistance or strengthening (NRM) for about 6 weeks. Motion (ROM) may begin at 2 weeks once the skin has healed. Physical Therapy Progressive gait, knee/ankle motion, and strengthening after healing milestones; therapy often helpful. Follow-Up / Imaging An X-ray at 6 weeks to confirm healing and clear the weight-bearing restriction. A return visit around 6–9 months is planned for hardware removal, once your child's surgeon confirms healing (a bridging callus across all three visible sides of the bone on X-ray). Expected Bone Healing About 8–12 weeks. Return to Work / School School with mobility accommodations; activity-based work restrictions until gait and union recover. Return to Sports / High-Risk Activity Often 3–4 months or longer, after painless running and radiographic union. Hardware Removal The elastic nail (flexible rod placed inside the bone during surgery) is typically removed in a short outpatient surgery around 6–9 months, once X-rays confirm solid healing across all three cortices (sides) of the bone. Bone Doc Pearl Elastic fixation supports alignment, but return to impact still depends on biologic union and gait recovery. Urgent Referral / Red Flags Infection, increasing pain/swelling, compartment symptoms, implant prominence, malalignment, or delayed union. Clinical Notes An elastic (flexible) nail is a smooth, bendable metal rod placed inside the bone to hold a shinbone (tibia) fracture in good position while it heals. It is designed to be removed once healing is confirmed. Full Patient Page Recovery After Elastic Nail Fixation of a Tibia Fracture →
	Tuft Fracture of Distal Phalanx Pediatric Nonoperative	Wrist and Hand	Protective fingertip or aluminum-foam splint for comfort, usually 2–3 weeks; keep the PIP joint free.	Light hand use as comfort allows; avoid impact, heavy gripping, and direct fingertip pressure.
Motion Begin DIP and PIP motion as pain allows unless associated with tendon injury. Physical Therapy Usually not required. Follow-Up / Imaging Clinical check in 1–2 weeks if open injury, nail-bed injury, or persistent symptoms. Expected Bone Healing About 4–6 weeks. Return to Work / School Desk/school as tolerated with protection; heavy work when comfortable grip and impact tolerance return. Return to Sports / High-Risk Activity Usually 6–8 weeks, depending on tenderness and sport. Bone Doc Pearl Treat the fingertip and nail bed—not just the X-ray. Urgent Referral / Red Flags Open injury, vascular compromise, significant nail-bed disruption, or Seymour fracture concern. Clinical Notes Assess nail plate, nail bed, skin integrity, and tetanus status. Open nail-bed injuries may require irrigation, repair, and antibiotics based on contamination. Full Patient Page Tuft Fracture of Distal Phalanx →
	Mallet Finger Pediatric Nonoperative	Wrist and Hand	Continuous DIP extension splinting for 6–8 weeks, followed by nighttime splinting as needed. Keep the PIP joint mobile.	Hand use is allowed while the DIP remains continuously extended in the splint.
Motion No DIP flexion during the continuous splint phase; maintain PIP motion. Physical Therapy Hand therapy if splint fit, skin care, or stiffness is difficult. Follow-Up / Imaging Recheck splint and skin within 1–2 weeks; reassess at 6–8 weeks. Expected Bone Healing Tendon healing typically 6–8 weeks; bony injuries may vary. Return to Work / School Work/school as tolerated in splint. Return to Sports / High-Risk Activity Return after painless motion and functional control, often 8–12 weeks. Hardware Removal If surgically treated, removal depends on fixation. Bone Doc Pearl The splint works only when extension is truly uninterrupted. Urgent Referral / Red Flags Volar subluxation, large articular fragment, open injury, inability to maintain reduction, or pediatric physeal injury. Clinical Notes Even brief DIP flexion can disrupt early healing and may restart the splinting timeline. Full Patient Page Mallet Finger →
	Volar Plate Injury of PIP Joint Pediatric Nonoperative	Wrist and Hand	Buddy tape or extension-block splint with the PIP protected from hyperextension for approximately 2–3 weeks.	Light hand use as tolerated; avoid forceful gripping and hyperextension.
Motion Begin early protected PIP flexion and extension to reduce stiffness. Physical Therapy Hand therapy if motion is limited or swelling persists. Follow-Up / Imaging Follow up in 1–2 weeks to confirm stability and motion. Expected Bone Healing Soft-tissue healing about 4–6 weeks; swelling may last longer. Return to Work / School Desk/school as tolerated; manual work based on grip and pain. Return to Sports / High-Risk Activity Usually 6–8 weeks when stable and pain-free. Bone Doc Pearl Stable PIP injuries need protection and motion—not prolonged immobilization. Urgent Referral / Red Flags Irreducible dislocation, unstable joint, large articular fragment, neurovascular compromise, or open injury. Clinical Notes Avoid prolonged rigid immobilization because PIP stiffness can become the dominant problem. Full Patient Page Volar Plate Injury of PIP Joint →
	Jersey Finger (FDP Avulsion) Pediatric Operative	Wrist and Hand	Temporary finger splint in a comfortable position while awaiting hand-surgery evaluation.	No forceful gripping, pulling, or sport.
Motion Avoid resisted DIP flexion. Physical Therapy Postoperative hand therapy per repair protocol. Follow-Up / Imaging Urgent hand-surgery evaluation, ideally within days. Expected Bone Healing Tendon-to-bone healing generally requires several weeks after repair. Return to Work / School Modified duty until cleared. Return to Sports / High-Risk Activity Return after repair healing and functional rehabilitation, commonly several months. Hardware Removal Per surgical fixation. Bone Doc Pearl A jersey finger is usually a surgical injury, not a sprain to watch casually. Urgent Referral / Red Flags Open injury, displaced bony avulsion, retracted tendon, neurovascular compromise. Clinical Notes Loss of active DIP flexion after forced finger extension is a tendon avulsion until proven otherwise. Full Patient Page Jersey Finger (FDP Avulsion) →
	Central Slip Injury / Early Boutonnière Pediatric Nonoperative	Wrist and Hand	Continuous PIP extension splinting with the DIP free, often 6 weeks for an acute closed injury.	Light hand use while protecting the PIP.
Motion Actively flex the DIP while maintaining PIP extension; no unprotected PIP flexion initially. Physical Therapy Hand therapy is strongly helpful for splint fit and tendon-gliding program. Follow-Up / Imaging Early follow-up in 1–2 weeks; reassess extension and deformity progression. Expected Bone Healing Soft-tissue healing commonly 6–8 weeks. Return to Work / School Modified work as needed. Return to Sports / High-Risk Activity Return when extension is maintained and sport-specific function is restored. Hardware Removal If operative, per fixation. Bone Doc Pearl PIP extension must be protected while the DIP keeps moving. Urgent Referral / Red Flags Open injury, displaced avulsion, unstable joint, or inability to maintain PIP extension. Clinical Notes A central slip injury can look minor early and declare itself later as a boutonnière deformity. Full Patient Page Central Slip Injury / Early Boutonnière →
	Stable Proximal Phalanx Fracture Pediatric Nonoperative	Wrist and Hand	Buddy tape or radial/ulnar gutter splint based on digit and fracture stability, usually about 3 weeks.	No heavy lifting or forceful gripping until clinical healing.
Motion Begin early protected motion once stability is confirmed, often within the first 1–2 weeks. Physical Therapy Hand therapy if stiffness, edema, or tendon adhesion develops. Follow-Up / Imaging Alignment check in about 1 week; additional follow-up based on stability. Expected Bone Healing Approximately 4–6 weeks. Return to Work / School Desk/school early; heavy work after union and functional grip return. Return to Sports / High-Risk Activity Often 6–8 weeks or later depending on sport and tenderness. Bone Doc Pearl Rotation is less tolerated than modest angulation. Urgent Referral / Red Flags Any rotational deformity, open fracture, unstable pattern, intra-articular displacement, tendon injury, or neurovascular deficit. Clinical Notes Examine the finger cascade and nail alignment with active flexion. Full Patient Page Stable Proximal Phalanx Fracture →
	Metacarpal Neck Fracture (Boxer’s Fracture) Pediatric Nonoperative	Wrist and Hand	Ulnar-gutter splint or functional brace with MCP joints flexed, generally 3–4 weeks for a stable fracture.	Light use only; avoid punching, impact, and heavy grip.
Motion Keep IP joints moving; begin protected MCP motion when stable. Physical Therapy Hand therapy if stiffness or loss of function develops. Follow-Up / Imaging Recheck alignment and rotation in about 1 week. Expected Bone Healing About 4–6 weeks. Return to Work / School Desk work early; manual labor after painless grip and healing. Return to Sports / High-Risk Activity Usually 6–8 weeks; longer for contact sports. Bone Doc Pearl Look at the finger cascade before accepting the X-ray. Urgent Referral / Red Flags Malrotation, open fight-bite wound, significant shortening, unstable reduction, intra-articular extension, or neurovascular deficit. Clinical Notes Acceptable angulation depends on the metacarpal, but clinical rotation must be absent. Full Patient Page Metacarpal Neck Fracture (Boxer’s Fracture) →
	Thumb UCL Injury (Skier’s / Gamekeeper’s Thumb) Pediatric Variable	Wrist and Hand	Thumb-spica splint or cast. Stable partial injuries are commonly protected 4–6 weeks; complete displaced tears may require repair.	No pinch, gripping, or valgus stress at the thumb MCP.
Motion Motion begins after the protection phase for stable injuries or per repair protocol. Physical Therapy Hand therapy for motion and pinch recovery. Follow-Up / Imaging Early review after swelling improves; prompt hand referral if complete tear suspected. Expected Bone Healing Ligament healing commonly 6 weeks or more. Return to Work / School Modified work avoiding pinch. Return to Sports / High-Risk Activity Return when painless stable pinch and sport-specific function return, often 8–12+ weeks. Hardware Removal Per repair. Bone Doc Pearl A complete unstable UCL tear is not just a thumb sprain. Urgent Referral / Red Flags Marked laxity without endpoint, displaced avulsion, suspected Stener lesion, open injury, or neurovascular deficit. Clinical Notes A Stener lesion prevents the ligament from healing in its normal position. Full Patient Page Thumb UCL Injury (Skier’s / Gamekeeper’s Thumb) →
	Lesser Toe Phalanx Fracture Pediatric Nonoperative	Foot	Buddy tape to adjacent toe and rigid-sole shoe, generally 2–4 weeks.	Weight bearing as tolerated in protective footwear.
Motion Toe motion as pain allows after early protection. Physical Therapy Usually not required. Follow-Up / Imaging Follow up as needed; earlier for displacement or skin concerns. Expected Bone Healing Approximately 4–6 weeks. Return to Work / School Return to work/school as footwear and pain allow. Return to Sports / High-Risk Activity Usually 4–6 weeks when able to run, cut, and push off without pain. Bone Doc Pearl Most lesser-toe fractures need comfort and alignment—not a cast. Urgent Referral / Red Flags Open fracture, significant rotation, irreducible displacement, vascular compromise, or physeal concern. Clinical Notes Check rotation, nail bed, and skin; protect tape with padding. Full Patient Page Lesser Toe Phalanx Fracture →
	Great Toe Phalanx Fracture Pediatric Variable	Foot	Rigid-sole shoe or boot; consider more rigid immobilization for proximal or intra-articular injuries.	Weight bearing as tolerated if stable, with protection.
Motion Begin motion after early pain decreases when stability permits. Physical Therapy Usually not required; therapy for persistent stiffness. Follow-Up / Imaging Follow up in 1–2 weeks for displaced, proximal, or intra-articular patterns. Expected Bone Healing Approximately 6 weeks, sometimes longer. Return to Work / School Work based on footwear and push-off demands. Return to Sports / High-Risk Activity Return after painless push-off and near-normal motion, often 6–8+ weeks. Hardware Removal If operative, per fixation. Bone Doc Pearl Treat the great toe as a functional joint, not just another toe. Urgent Referral / Red Flags Open injury, displacement, significant articular involvement, instability, or neurovascular deficit. Clinical Notes The great toe is important for balance and push-off, so alignment matters more than in the lesser toes. Full Patient Page Great Toe Phalanx Fracture →
	Nursemaid’s Elbow Pediatric Nonoperative	Elbow and Forearm	No immobilization after successful reduction.	Use the arm as tolerated once comfortable.
Motion Immediate return of motion is expected, though some children take a short time to resume use. Physical Therapy Not required. Follow-Up / Imaging No routine follow-up after classic presentation and successful reduction. Expected Bone Healing Immediate. Return to Work / School Return to school/daycare immediately as comfortable. Return to Sports / High-Risk Activity Normal play as tolerated. Bone Doc Pearl A child who does not resume use after reduction needs another look. Urgent Referral / Red Flags Swelling, deformity, focal bony tenderness, atypical age/mechanism, failed reductions, fever, or neurovascular concern. Clinical Notes Avoid pulling or swinging a young child by the hands or forearms. Full Patient Page Nursemaid’s Elbow →
	Toddler’s Fracture of Tibia Pediatric Nonoperative	Foot	Walking boot or short-leg immobilization for comfort; some stable cases can be managed with minimal immobilization.	Weight bearing as tolerated when comfortable.
Motion Hip, knee, and toe motion encouraged. Physical Therapy Not usually required. Follow-Up / Imaging Clinical follow-up in several weeks if symptoms persist. Expected Bone Healing Approximately 3–4 weeks. Return to Work / School Return to daycare/school as comfort allows. Return to Sports / High-Risk Activity Normal play after painless walking; avoid high-risk activity until comfortable. Bone Doc Pearl Treat the child’s comfort and gait, not just the first X-ray. Urgent Referral / Red Flags Fever, systemic illness, inability to localize pain, swelling, neurovascular deficit, nonaccidental-trauma concern, or persistent symptoms. Clinical Notes A limping toddler can have a subtle tibial fracture with initially normal X-rays. Full Patient Page Toddler’s Fracture of Tibia →
	Tillaux Fracture Pediatric Variable	Leg and Ankle	Short-leg cast or splint after reduction; treatment depends on articular displacement.	Non-weight bearing initially.
Motion Toe and knee motion; ankle motion after healing phase. Physical Therapy Therapy if motion or gait recovery is delayed. Follow-Up / Imaging Prompt pediatric orthopedic follow-up. Expected Bone Healing Approximately 6 weeks, with return to activity later. Return to Work / School School with restrictions; sports after healing and functional recovery. Return to Sports / High-Risk Activity Usually 3–4 months or longer depending on severity. Hardware Removal Per fixation. Bone Doc Pearl Small articular displacement matters in a Tillaux fracture. Urgent Referral / Red Flags Articular displacement, inability to maintain reduction, open injury, skin threat, or neurovascular deficit. Clinical Notes This transitional fracture occurs near physeal closure and is judged by joint congruity. Full Patient Page Tillaux Fracture →
	Triplane Fracture Pediatric Variable	Leg and Ankle	Long- or short-leg immobilization after reduction depending on pattern; operative treatment based on articular displacement.	Non-weight bearing initially.
Motion Maintain toe and knee motion; ankle motion after protection phase. Physical Therapy Therapy as needed for gait and motion. Follow-Up / Imaging Prompt pediatric orthopedic follow-up. Expected Bone Healing Approximately 6 weeks or longer. Return to Work / School School with restrictions. Return to Sports / High-Risk Activity Usually several months after healing and functional testing. Hardware Removal Per fixation. Bone Doc Pearl CT helps turn a confusing transitional fracture into a clear treatment plan. Urgent Referral / Red Flags Articular displacement, unstable reduction, open injury, compartment concern, skin threat, or neurovascular deficit. Clinical Notes The fracture crosses three planes and can look deceptively different on each X-ray view. Full Patient Page Triplane Fracture →
	Ankle Fracture (Without Syndesmotic Injury) Adult Variable	Leg and Ankle	A short-leg splint (SLS) for about 2 weeks, then transition to a CAM boot (controlled ankle motion boot).	No weight bearing (NWB) for about 2 weeks.
Motion No resistance or strengthening (NRM) for about 6 weeks. Motion (ROM) may begin around 2 weeks once the skin has healed, as you transition to a CAM boot while weight-bearing restrictions continue. Physical Therapy Ankle motion, gait, balance, and strengthening after the protection phase; formal therapy if needed. Follow-Up / Imaging A 6–8 week X-ray to confirm healing and clear the weight-bearing restriction. An optional 3–6 month X-ray may be used to monitor final healing. Expected Bone Healing About 6–8 weeks. Return to Work / School Desk work early; standing/manual work after comfortable gait and adequate healing. Return to Sports / High-Risk Activity Usually 10–12 weeks or longer, after strength, balance, and impact tolerance return. Bone Doc Pearl An ankle can be healed on X-ray before balance, calf strength, and confidence are fully restored. Urgent Referral / Red Flags Loss of alignment, wound problems, calf pain, neurovascular symptoms, increasing swelling, or inability to progress. Clinical Notes This protocol applies to ankle fractures that do not involve the syndesmosis (the strong ligament complex connecting the two lower leg bones just above the ankle). Patients with diabetes may be kept non-weight-bearing longer — see your surgeon's specific instructions. Full Patient Page Ankle Fracture (Without Syndesmotic Injury) →
	Ankle Fracture With Syndesmotic Injury Adult Variable	Leg and Ankle	A short-leg splint (SLS) for about 2 weeks, then transition to a CAM boot (controlled ankle motion boot).	No weight bearing (NWB) for about 6 weeks. Patients with diabetes are generally kept non-weight-bearing longer — about 12 weeks — given the higher risk of bone-healing complications.
Motion No resistance or strengthening (NRM) for about 6 weeks (12 weeks for patients with diabetes). If treated with surgery, motion (ROM) may begin around 2 weeks once the skin has healed, as you transition to a CAM boot while weight-bearing restrictions continue. Physical Therapy Structured ankle motion, gait, calf strength, and balance rehabilitation after stability permits. Follow-Up / Imaging A 6–8 week X-ray to confirm healing and clear the weight-bearing restriction. An optional 3–6 month X-ray may be used to monitor final healing. Expected Bone Healing About 8–12 weeks or longer. Return to Work / School Desk work early; standing/manual work delayed until stable gait and healing. Return to Sports / High-Risk Activity Often 4–6 months, depending on syndesmotic healing and functional testing. Bone Doc Pearl Syndesmotic injuries usually recover more slowly than an isolated ankle fracture. Urgent Referral / Red Flags Mortise widening, wound problems, calf pain, neurovascular symptoms, hardware pain, or persistent instability. Clinical Notes The syndesmosis is the strong ligament complex holding the two lower leg bones together just above the ankle joint. An injury here typically requires a longer non-weight-bearing period than an ankle fracture without this involvement, to protect healing. Full Patient Page Ankle Fracture With Syndesmotic Injury →
	Bimalleolar or Trimalleolar Ankle Fracture Adult Variable	Leg and Ankle	A short-leg splint (SLS) for about 2 weeks, then transition to a CAM boot (controlled ankle motion boot).	No weight bearing (NWB) for about 2 weeks; patients with diabetes are typically kept non-weight-bearing for about 6–12 weeks.
Motion No resistance or strengthening (NRM) for about 6 weeks (12 weeks for patients with diabetes). If treated with surgery, motion (ROM) may begin around 2 weeks once the skin has healed, as you transition to a CAM boot. Physical Therapy Formal therapy is commonly helpful for motion, gait, strength, and balance after protection. Follow-Up / Imaging A 6–8 week X-ray to confirm healing and clear the weight-bearing restriction. An optional 3–6 month X-ray may be used to monitor final healing. Expected Bone Healing About 8–12 weeks. Return to Work / School Desk work early; prolonged restriction for standing, climbing, or heavy labor. Return to Sports / High-Risk Activity Often 4–6 months or longer, after strength and balance recover. Bone Doc Pearl Complex ankle fractures are joint injuries; swelling and stiffness often outlast bone healing. Urgent Referral / Red Flags Wound issues, loss of reduction, calf pain, neurovascular symptoms, infection, or persistent instability. Clinical Notes A bimalleolar fracture involves two of the bony prominences around the ankle joint; a trimalleolar fracture involves three. These are more complex ankle fracture patterns that often benefit from surgical stabilization. Full Patient Page Bimalleolar or Trimalleolar Ankle Fracture →
	Nonoperative Calcaneus (Heel Bone) Fracture Adult Nonoperative	Foot	A bulky Jones splint for about 2–4 weeks.	No weight bearing (NWB) for about 12 weeks.
Motion No resistance or strengthening (NRM) for about 12 weeks. Physical Therapy Ankle/subtalar motion when allowed; later gait and strengthening therapy may be beneficial. Follow-Up / Imaging A 6–8 week X-ray to check healing, then a 12-week X-ray to confirm healing and clear the weight-bearing restriction. An optional 6–9 month X-ray may be used to monitor final healing. Expected Bone Healing About 10–12 weeks or longer. Return to Work / School Desk work may resume early; standing/manual work often requires several months. Return to Sports / High-Risk Activity Often 4–6 months or longer; impact may remain limited by subtalar symptoms. Bone Doc Pearl Heel fractures can unite while swelling, shoe intolerance, and subtalar stiffness continue for months. Urgent Referral / Red Flags Skin compromise, increasing swelling, compartment symptoms, neurovascular deficit, displacement, or inability to maintain restrictions. Clinical Notes The calcaneus (heel bone) bears significant weight with every step, which is why non-weight-bearing periods for this fracture tend to be longer than for many other fractures. Full Patient Page Nonoperative Calcaneus (Heel Bone) Fracture →
	Operative Calcaneus (Heel Bone) Fracture Adult Operative	Foot	A short-leg splint for about 2 weeks after surgery, then transition toward a CAM boot (controlled ankle motion boot).	No weight bearing (NWB) for about 12 weeks.
Motion No resistance or strengthening (NRM) for about 12 weeks. Motion (ROM) may begin around 2 weeks once the skin has healed if treated with surgery. Physical Therapy Formal therapy for ankle/subtalar motion, gait, and strength after wound and fixation milestones. Follow-Up / Imaging A 6–8 week X-ray to check healing, then a 12-week X-ray to confirm further healing and clear the weight-bearing restriction. An optional 6–9 month X-ray may be used to monitor final healing. Expected Bone Healing About 10–12 weeks or longer. Return to Work / School Desk work after wound recovery; standing/manual work often delayed several months. Return to Sports / High-Risk Activity Often 6 months or longer depending on subtalar motion and impact tolerance. Bone Doc Pearl For calcaneus fractures, soft-tissue recovery is as important as fixation. Urgent Referral / Red Flags Wound drainage or necrosis, infection, increasing pain, neurovascular symptoms, hardware problems, or loss of reduction. Clinical Notes The calcaneus (heel bone) bears significant weight with every step, which is why non-weight-bearing periods for this fracture tend to be longer than for many other fractures, whether treated with or without surgery. Full Patient Page Operative Calcaneus (Heel Bone) Fracture →
	Femoral Neck Fracture — Fixation (Screws) Adult Operative	Pelvis and Hip	A walker or cane, used until you're able to return to your prior baseline level of assistance.	Weight bearing as tolerated (WBAT) — you may put as much weight on the leg as feels comfortable, using a walker or cane for balance as needed.
Motion Lower-extremity range of motion (ROM) may begin after surgery, with light exercises added around 2–4 weeks. Physical Therapy Early gait training and hip strengthening; formal therapy is usually appropriate. Follow-Up / Imaging A 6–8 week X-ray to confirm healing. An optional 3–6 month X-ray may be used to monitor final healing. Expected Bone Healing About 10–12 weeks, with continued surveillance for complications. Return to Work / School Desk work based on mobility; physical work after union and strength recovery. Return to Sports / High-Risk Activity Usually several months; return depends on union, pain, and risk of avascular necrosis. Bone Doc Pearl Fixation preserves the native hip, but union and femoral-head blood supply both require follow-up. Urgent Referral / Red Flags Increasing groin pain, shortening, loss of fixation, wound issues, infection, DVT symptoms, nonunion, or avascular necrosis. Clinical Notes This describes a fracture near the top of the thighbone, close to the hip joint, stabilized with screws. Weight-bearing status after femoral neck fixation can vary based on the specific fracture pattern and bone quality — always follow your surgeon's individual instructions. Full Patient Page Femoral Neck Fracture — Fixation (Screws) →
	Intertrochanteric Hip Fracture Adult Operative	Pelvis and Hip	A walker or cane, used until you're able to return to your prior baseline level of assistance.	Weight bearing as tolerated (WBAT) — you may put as much weight on the leg as feels comfortable, using a walker or cane for balance as needed. If bone loss was severe, your surgeon may instead start you at partial or touch-down weight bearing.
Motion Lower-extremity range of motion (ROM) may begin after surgery, with light exercises added around 2–4 weeks. Physical Therapy Early gait, transfers, balance, and lower-extremity strengthening; formal therapy is standard. Follow-Up / Imaging A 6–8 week X-ray to confirm healing. An optional 3–6 month X-ray may be used to monitor final healing. Expected Bone Healing About 8–12 weeks. Return to Work / School Return depends on preinjury function; desk work may precede full mobility recovery. Return to Sports / High-Risk Activity Low-impact activity after healing and strength recovery; high-risk activity individualized. Bone Doc Pearl Early mobilization is important even though strength and independence may take months to recover. Urgent Referral / Red Flags Wound problems, increasing pain, inability to bear weight, DVT symptoms, infection, hardware failure, or loss of alignment. Clinical Notes An intertrochanteric fracture occurs in the upper thighbone just below the hip joint, and is typically stabilized with a plate/screw or rod construct. Getting up and moving safely (often with physical therapy) soon after surgery is an important part of recovery for this fracture. Full Patient Page Intertrochanteric Hip Fracture →
	Patella (Kneecap) Fracture After Surgery Adult Operative	Thigh and Knee	A knee immobilizer for the first 6 weeks, worn while walking.	Weight bearing as tolerated (WBAT) from the start.
Motion The knee is kept straight in the immobilizer for 6 weeks. At 6 weeks, you transition to a hinged knee brace (HKB) locked straight for walking; your surgeon then gradually unlocks the brace, typically starting with 0–30 degrees of motion and increasing by about 20 degrees per week. Physical Therapy Quadriceps activation and staged knee motion per fixation stability; formal therapy is commonly required. Follow-Up / Imaging A 2-week skin check with suture removal, then a 6–8 week X-ray to confirm healing. An optional 3–6 month X-ray may be used to monitor final healing. Expected Bone Healing About 8–12 weeks. Return to Work / School Desk work with brace accommodations; kneeling, stairs, and manual work later. Return to Sports / High-Risk Activity Usually 3–6 months after extensor strength and motion recover. Bone Doc Pearl The extensor mechanism must heal while knee stiffness is actively prevented. Urgent Referral / Red Flags Wound drainage, loss of active extension, increasing gap, infection, hardware irritation, or loss of fixation. Clinical Notes The patella (kneecap) helps the thigh muscles straighten the knee, so protecting the repair while it heals — before allowing bending — is an important early step. Full Patient Page Patella (Kneecap) Fracture After Surgery →
	Nonoperative Patella (Kneecap) Fracture Adult Nonoperative	Thigh and Knee	A knee immobilizer, worn for about 6 weeks.	Weight bearing as tolerated (WBAT) from the start.
Motion The knee is kept straight in the knee immobilizer for about 3–4 weeks. You'll then transition to a hinged knee brace locked from 0–50 degrees, increasing 10–20 degrees each week until reaching 90 degrees of flexion, at which point the brace can be discontinued. Physical Therapy Quadriceps activation and staged knee motion once stability is confirmed; therapy if motion or strength lags. Follow-Up / Imaging A 6–8 week X-ray to confirm healing. An optional 3–6 month X-ray may be used to monitor final healing. Expected Bone Healing About 6–8 weeks. Return to Work / School Desk work with brace; prolonged standing, kneeling, and climbing based on symptoms. Return to Sports / High-Risk Activity Usually 10–12 weeks or longer after painless motion and extensor strength return. Bone Doc Pearl An intact straight-leg raise is a key part of deciding whether nonoperative care is appropriate. Urgent Referral / Red Flags Loss of active extension, displacement, increasing swelling, skin compromise, or neurovascular symptoms. Clinical Notes Some patella (kneecap) fractures that remain in good alignment can be treated without surgery, protecting the knee in a straight position while the bone heals. Full Patient Page Nonoperative Patella (Kneecap) Fracture →
	Tibial Plateau Fracture Adult Variable	Thigh and Knee	A knee immobilizer.	No weight bearing (NWB) for about 12 weeks.
Motion Knee range of motion (ROM) begins around 2 weeks. Physical Therapy Formal therapy for knee motion, quadriceps strength, gait, and balance after stability allows. Follow-Up / Imaging A 6–8 week X-ray to check healing, then a 12-week X-ray to confirm healing and clear the weight-bearing restriction. An optional 6–9 month X-ray may be used to monitor final healing. Expected Bone Healing About 10–12 weeks or longer. Return to Work / School Desk work with mobility accommodations; standing/manual work often delayed several months. Return to Sports / High-Risk Activity Often 4–6 months or longer depending on joint injury and strength. Bone Doc Pearl A tibial plateau fracture is both a bone injury and a cartilage/meniscus injury. Urgent Referral / Red Flags Compartment symptoms, increasing swelling, neurovascular changes, loss of alignment, wound issues, or DVT symptoms. Clinical Notes The tibial plateau is the top surface of the shinbone that forms part of the knee joint. Protecting this weight-bearing surface while it heals — while still working on knee motion early — helps preserve knee function. Full Patient Page Tibial Plateau Fracture →
	Tibial Shaft Fracture — Mid-Shaft (IM Nail) Adult Operative	Leg and Ankle	A walker or cane, used until you're able to return to your prior baseline level of assistance.	Weight bearing as tolerated (WBAT), typically starting soon after surgery.
Motion Knee range of motion (ROM) may begin after surgery, with light exercises added around 2 weeks. Physical Therapy Early knee/ankle motion, gait progression, and strengthening; formal therapy if gait or motion lags. Follow-Up / Imaging A 2-week skin check with suture removal, then a 6–8 week X-ray to confirm healing. An optional 3–6 month X-ray may be used to monitor final healing. Expected Bone Healing About 3–4 months, sometimes longer. Return to Work / School Desk work early; manual labor after union and functional strength return. Return to Sports / High-Risk Activity Often 4–6 months after painless running, hopping, and radiographic union. Bone Doc Pearl Weight bearing may advance before complete radiographic union, but impact activity should not. Urgent Referral / Red Flags Compartment symptoms, increasing pain, wound drainage, infection, malalignment, hardware pain, or delayed union. Clinical Notes This describes a fracture in the middle portion of the shinbone (tibia) stabilized with an intramedullary nail (IMN) — a rod placed inside the bone's central canal. Mid-shaft fractures fixed this way are often able to bear weight sooner than fractures nearer the ends of the bone. Full Patient Page Tibial Shaft Fracture — Mid-Shaft (IM Nail) →
	Tibial Shaft Fracture — Proximal or Distal Adult Operative	Leg and Ankle	A walker or cane, used until you're able to return to your prior baseline level of assistance.	Weight bearing as tolerated (WBAT), typically starting soon after surgery — if the fracture doesn't extend into the joint. If it does extend into the joint, no weight bearing (NWB) for about 8–12 weeks.
Motion Knee and ankle range of motion (ROM) begins around 2 weeks. Physical Therapy Formal therapy for knee/ankle motion, gait, and strength after alignment and healing milestones. Expected Bone Healing About 3–4 months or longer. Return to Work / School Desk work early; standing/manual work after union and stable gait. Return to Sports / High-Risk Activity Often 4–6 months or longer depending on location and joint involvement. Bone Doc Pearl Proximal and distal tibial fractures need close alignment surveillance because malalignment can affect adjacent joints. Urgent Referral / Red Flags Loss of alignment, compartment symptoms, neurovascular changes, wound problems, infection, or delayed union. Clinical Notes Fractures near the ends of the shinbone (tibia) — closer to the knee or ankle — are generally protected with a longer non-weight-bearing period than fractures in the middle of the shaft, because the bone has less surrounding support at these locations. Full Patient Page Tibial Shaft Fracture — Proximal or Distal →
	Clavicle (Collarbone) Fracture Adult Variable	Shoulder and Upper Arm	A sling.	No pushing, pulling, or lifting with the affected arm for about 6 weeks.
Motion No resistance or strengthening (NRM) with the shoulder for about 6 weeks. Gentle pendulum exercises (letting the arm hang and gently swing) typically begin around 2 weeks. Physical Therapy Usually home shoulder motion; therapy if motion or strength does not recover as expected. Follow-Up / Imaging Follow-up visits with X-rays at 2 weeks and 6–8 weeks. Expected Bone Healing About 6–8 weeks in adults; often faster in children. Return to Work / School Desk/school as tolerated; lifting and overhead work after healing and strength return. Return to Sports / High-Risk Activity Usually 8–12 weeks; contact sports after painless union and full function. Bone Doc Pearl A visible bump can remain even when the clavicle heals and functions well. Urgent Referral / Red Flags Skin tenting, open injury, neurovascular symptoms, increasing displacement, breathing symptoms, or nonunion. Clinical Notes This protocol applies whether your clavicle (collarbone) fracture is being treated with or without surgery — the emphasis in the early weeks is protecting the shoulder from load-bearing activity while it heals. Full Patient Page Clavicle (Collarbone) Fracture →
	Scapula (Shoulder Blade) Fracture Adult Variable	Shoulder and Upper Arm	A sling.	Weight bearing as tolerated (WBAT) on the arm for most scapula fractures. If the fracture involves the socket (glenoid) or the neck of the shoulder blade, a more cautious approach is used instead — see Motion below.
Motion No resistance or strengthening (NRM) is advised for about 6 weeks for fractures involving the glenoid or neck of the shoulder blade. Gentle pendulum exercises (letting the arm hang and gently swing) typically begin around 2 weeks. Physical Therapy Shoulder motion and scapular strengthening after comfort and associated injuries permit; therapy often helpful. Follow-Up / Imaging Follow-up visits with X-rays at 2 weeks and 6–8 weeks. Expected Bone Healing About 6–8 weeks. Return to Work / School Desk work as tolerated; lifting/manual work after motion and strength recover. Return to Sports / High-Risk Activity Usually 8–12 weeks or longer depending on associated chest/shoulder injuries. Bone Doc Pearl A scapula fracture often signals substantial energy—look carefully for associated chest and shoulder injuries. Urgent Referral / Red Flags Breathing difficulty, chest pain, neurovascular deficit, significant displacement, glenoid involvement, or associated trauma. Clinical Notes The scapula (shoulder blade) is surrounded by muscle, so many fractures here heal well without surgery. Fractures that extend into the shoulder socket (glenoid) or the neck of the shoulder blade are treated more cautiously in the early weeks. Full Patient Page Scapula (Shoulder Blade) Fracture →
	Operative Proximal Humerus Fracture Adult Operative	Shoulder and Upper Arm	No formal immobilization is required; a sling is used for comfort.	No weight bearing (NWB) for about 6 weeks.
Motion No resistance or strengthening (NRM) for about 6 weeks. Gentle pendulum exercises (letting the arm hang and gently swing) typically begin around 2 weeks. Physical Therapy Formal staged shoulder rehabilitation based on fixation, tuberosity healing, and surgeon protocol. Follow-Up / Imaging A 2-week skin check with suture removal, then a 6–8 week X-ray to confirm healing. An optional 3–6 month X-ray may be used to monitor final healing. Expected Bone Healing About 8–12 weeks. Return to Work / School Desk work with arm protection; overhead/manual work after union and strength recovery. Return to Sports / High-Risk Activity Often 4–6 months or longer depending on motion, strength, and sport. Bone Doc Pearl Protecting fixation and restoring motion must be balanced carefully after proximal humerus surgery. Urgent Referral / Red Flags Wound drainage, increasing pain, loss of fixation, neurovascular symptoms, infection, stiffness, or avascular necrosis. Clinical Notes The proximal humerus is the upper part of the arm bone, near the shoulder. After surgical repair, early gentle motion (like pendulum exercises) is balanced against protecting the repair from load and resistance. Full Patient Page Operative Proximal Humerus Fracture →
	Nonoperative Proximal Humerus Fracture Adult Nonoperative	Shoulder and Upper Arm	A sling.	No weight bearing (NWB) for about 6 weeks.
Motion No resistance or strengthening (NRM) for about 6 weeks. Physical Therapy Pendulum and staged shoulder motion when safe; formal therapy is often helpful after early healing. Follow-Up / Imaging A follow-up visit around 1–2 weeks to recheck alignment on X-ray, then a 6–8 week X-ray to confirm healing. An optional 6–9 month X-ray may be used to monitor final healing. Expected Bone Healing About 6–8 weeks, sometimes longer. Return to Work / School Desk work with sling accommodations; lifting and overhead work later. Return to Sports / High-Risk Activity Often 3–4 months or longer after motion and strength recover. Bone Doc Pearl Prolonged sling use can create more disability from stiffness than the fracture itself once early stability is present. Urgent Referral / Red Flags Increasing displacement, neurovascular symptoms, uncontrolled pain, skin compromise, or inability to begin recovery. Clinical Notes Many proximal humerus (upper arm, near the shoulder) fractures that are well-aligned can be treated without surgery, with the shoulder protected from resistance while the bone heals. Full Patient Page Nonoperative Proximal Humerus Fracture →
	Distal Humerus Fracture Adult Variable	Elbow and Forearm	A long-arm splint (LAS) for about 3 weeks.	No weight bearing (NWB) through the arm for about 12 weeks.
Motion Range-of-motion (ROM) exercises for the elbow typically begin right away after surgery. Physical Therapy Formal elbow therapy is commonly essential once fixation or fracture stability permits motion. Follow-Up / Imaging A follow-up visit around 1–2 weeks to recheck alignment on X-ray, then a 6–8 week X-ray to confirm healing. An optional 6–9 month X-ray may be used to monitor final healing. Expected Bone Healing About 8–12 weeks. Return to Work / School Desk work with restrictions; lifting/manual work after union and functional motion. Return to Sports / High-Risk Activity Often 4–6 months or longer. Bone Doc Pearl The elbow becomes stiff quickly, so stable fixation and timely motion are important. Urgent Referral / Red Flags Neurovascular symptoms, wound problems, infection, loss of fixation, increasing deformity, or severe stiffness. Clinical Notes The distal humerus is the lower end of the upper arm bone, forming the top of the elbow joint. Even though weight bearing through the arm is restricted for an extended period, early elbow motion is prioritized to help prevent stiffness. Full Patient Page Distal Humerus Fracture →
	Olecranon Fracture After Surgery Adult Operative	Elbow and Forearm	A long-arm splint or cast for about 3 weeks if the fracture pattern is comminuted (broken into several pieces).	No weight bearing (NWB) through the arm for about 6 weeks.
Motion Range of motion (ROM) typically begins after 3 weeks. No resistance or strengthening (NRM) through the arm continues for about 6 weeks. Physical Therapy Formal or guided elbow motion based on fixation; later triceps strengthening. Follow-Up / Imaging A follow-up visit around 1–2 weeks to recheck alignment on X-ray, then a 6–8 week X-ray to confirm healing. An optional 6–9 month X-ray may be used to monitor final healing. Expected Bone Healing About 8–12 weeks. Return to Work / School Desk work early with protection; pushing, lifting, and manual work later. Return to Sports / High-Risk Activity Often 3–4 months or longer after triceps strength and motion return. Bone Doc Pearl Posterior elbow hardware is prominent and may remain noticeable even after successful healing. Urgent Referral / Red Flags Wound issues, infection, loss of extension, fixation failure, ulnar nerve symptoms, or symptomatic hardware. Clinical Notes The olecranon is the bony point of the elbow, where the triceps tendon attaches. Fractures that are broken into several pieces (comminuted) are typically protected in a splint or cast for longer than simpler fracture patterns. Full Patient Page Olecranon Fracture After Surgery →
	Radius and Ulna Shaft Fracture Adult Operative	Elbow and Forearm	A long-arm splint (LAS) for about 2 weeks, then a short-arm cast (SAC) for about 4 more weeks.	No weight bearing (NWB) through the arm for about 6 weeks.
Motion No resistance or strengthening (NRM) through the arm for about 6 weeks. Physical Therapy Formal therapy for forearm rotation, wrist/elbow motion, and strength after healing permits. Follow-Up / Imaging A follow-up visit around 1–2 weeks to recheck alignment on X-ray, then a 6–8 week X-ray to confirm healing. An optional 6–9 month X-ray may be used to monitor final healing. Expected Bone Healing About 8–12 weeks or longer. Return to Work / School Desk work with restrictions; heavy work after union and functional rotation return. Return to Sports / High-Risk Activity Often 3–4 months or longer. Bone Doc Pearl Restoring radial bow and forearm rotation is central to functional recovery. Urgent Referral / Red Flags Compartment symptoms, neurovascular deficit, infection, loss of alignment, synostosis, or delayed union. Clinical Notes This describes a fracture of both forearm bones (radius and ulna) together in an adult, typically stabilized with surgery given the load these two bones share with everyday arm rotation. Full Patient Page Radius and Ulna Shaft Fracture →
	Nonoperative Distal Radius Fracture Adult Nonoperative	Wrist and Hand	A long-arm splint (LAS) for about 2 weeks, then a short-arm cast (SAC) for about 4 more weeks.	No weight bearing (NWB) through the arm for about 6 weeks.
Motion No resistance or strengthening (NRM) through the wrist for about 6 weeks. Physical Therapy Home wrist/finger motion after immobilization; formal therapy if stiffness, edema, or function lags. Follow-Up / Imaging A follow-up visit around 1–2 weeks to recheck alignment on X-ray, then a 6–8 week X-ray to confirm healing. An optional 6–9 month X-ray may be used to monitor final healing. Expected Bone Healing About 6 weeks, sometimes longer. Return to Work / School Desk work with restrictions; lifting/manual work after healing and grip recovery. Return to Sports / High-Risk Activity Usually 8–12 weeks after painless motion and functional strength return. Bone Doc Pearl Finger motion and swelling control should begin while the wrist is still protected. Urgent Referral / Red Flags Loss of reduction, increasing numbness, tendon symptoms, skin problems, or persistent deformity/pain. Clinical Notes Distal radius (wrist) fractures that remain in good alignment can often be treated without surgery, protecting the wrist from resistance and strengthening while the bone heals. Full Patient Page Nonoperative Distal Radius Fracture →
	Distal Radius Fracture After Surgery — Simple Pattern Adult Operative	Wrist and Hand	A volar cock-up splint for about 2 weeks, then a wrist brace for about 6 more weeks.	No weight bearing (NWB) through the wrist for about 6 weeks.
Motion No resistance or strengthening (NRM) through the wrist for about 6 weeks. Physical Therapy Early finger motion and staged wrist therapy according to fixation stability; formal therapy as needed. Follow-Up / Imaging A follow-up visit around 1–2 weeks to recheck alignment on X-ray, then a 6–8 week X-ray to confirm healing. An optional 6–9 month X-ray may be used to monitor final healing. Expected Bone Healing About 6–8 weeks. Return to Work / School Desk work early with restrictions; lifting/manual work after union and grip recovery. Return to Sports / High-Risk Activity Usually 10–12 weeks or longer after motion and strength improve. Bone Doc Pearl Stable fixation can permit earlier motion, but it does not eliminate the biology of fracture healing. Urgent Referral / Red Flags Wound issues, infection, increasing numbness, tendon irritation/rupture, loss of fixation, or complex regional pain. Clinical Notes This protocol applies to a straightforward (simple) fracture pattern treated with surgery — generally a more predictable recovery course than a severely comminuted fracture. Full Patient Page Distal Radius Fracture After Surgery — Simple Pattern →
	Distal Radius Fracture After Surgery — Severe/Comminuted Pattern Adult Operative	Wrist and Hand	A long-arm splint, then a short-arm cast, for a total of about 8 weeks.	No weight bearing (NWB) through the wrist for about 8 weeks.
Motion No resistance or strengthening (NRM) through the wrist for about 8 weeks. Physical Therapy Finger motion immediately; staged wrist/forearm therapy after cast or spanning-plate milestones. Follow-Up / Imaging A follow-up visit around 2 weeks for a skin check and suture removal, then a 6–8 week X-ray to confirm healing. If a dorsal spanning plate was used, a return visit around 2 months is generally planned for hardware removal. An optional 6–9 month X-ray may be used to monitor final healing. Expected Bone Healing About 8–12 weeks or longer. Return to Work / School Desk work with restrictions; lifting/manual work after plate removal if applicable and healing. Return to Sports / High-Risk Activity Often 3–4 months or longer depending on comminution and stiffness. Hardware Removal If a dorsal spanning plate was used to stabilize a severely broken (comminuted) fracture, hardware removal is typically planned around 2 months after surgery. Bone Doc Pearl Severe comminution often means a longer stiffness and recovery timeline even when alignment is restored. Urgent Referral / Red Flags Wound issues, infection, numbness, tendon problems, loss of fixation, hardware complications, or complex regional pain. Clinical Notes A severely comminuted distal radius fracture — broken into several pieces — sometimes requires a spanning plate for extra stability, which is generally removed once the bone has healed enough to no longer need it. Full Patient Page Distal Radius Fracture After Surgery — Severe/Comminuted Pattern →
	Tuft Fracture of Distal Phalanx Adult Nonoperative	Wrist and Hand	Protective fingertip or aluminum-foam splint for comfort, usually 2–3 weeks; keep the PIP joint free.	Light hand use as comfort allows; avoid impact, heavy gripping, and direct fingertip pressure.
Motion Begin DIP and PIP motion as pain allows unless associated with tendon injury. Physical Therapy Usually not required. Follow-Up / Imaging Clinical check in 1–2 weeks if open injury, nail-bed injury, or persistent symptoms. Expected Bone Healing About 4–6 weeks. Return to Work / School Desk/school as tolerated with protection; heavy work when comfortable grip and impact tolerance return. Return to Sports / High-Risk Activity Usually 6–8 weeks, depending on tenderness and sport. Bone Doc Pearl Treat the fingertip and nail bed—not just the X-ray. Urgent Referral / Red Flags Open injury, vascular compromise, significant nail-bed disruption, or Seymour fracture concern. Clinical Notes Assess nail plate, nail bed, skin integrity, and tetanus status. Open nail-bed injuries may require irrigation, repair, and antibiotics based on contamination. Full Patient Page Tuft Fracture of Distal Phalanx →
	Mallet Finger Adult Nonoperative	Wrist and Hand	Continuous DIP extension splinting for 6–8 weeks, followed by nighttime splinting as needed. Keep the PIP joint mobile.	Hand use is allowed while the DIP remains continuously extended in the splint.
Motion No DIP flexion during the continuous splint phase; maintain PIP motion. Physical Therapy Hand therapy if splint fit, skin care, or stiffness is difficult. Follow-Up / Imaging Recheck splint and skin within 1–2 weeks; reassess at 6–8 weeks. Expected Bone Healing Tendon healing typically 6–8 weeks; bony injuries may vary. Return to Work / School Work/school as tolerated in splint. Return to Sports / High-Risk Activity Return after painless motion and functional control, often 8–12 weeks. Hardware Removal If surgically treated, removal depends on fixation. Bone Doc Pearl The splint works only when extension is truly uninterrupted. Urgent Referral / Red Flags Volar subluxation, large articular fragment, open injury, inability to maintain reduction, or pediatric physeal injury. Clinical Notes Even brief DIP flexion can disrupt early healing and may restart the splinting timeline. Full Patient Page Mallet Finger →
	Volar Plate Injury of PIP Joint Adult Nonoperative	Wrist and Hand	Buddy tape or extension-block splint with the PIP protected from hyperextension for approximately 2–3 weeks.	Light hand use as tolerated; avoid forceful gripping and hyperextension.
Motion Begin early protected PIP flexion and extension to reduce stiffness. Physical Therapy Hand therapy if motion is limited or swelling persists. Follow-Up / Imaging Follow up in 1–2 weeks to confirm stability and motion. Expected Bone Healing Soft-tissue healing about 4–6 weeks; swelling may last longer. Return to Work / School Desk/school as tolerated; manual work based on grip and pain. Return to Sports / High-Risk Activity Usually 6–8 weeks when stable and pain-free. Bone Doc Pearl Stable PIP injuries need protection and motion—not prolonged immobilization. Urgent Referral / Red Flags Irreducible dislocation, unstable joint, large articular fragment, neurovascular compromise, or open injury. Clinical Notes Avoid prolonged rigid immobilization because PIP stiffness can become the dominant problem. Full Patient Page Volar Plate Injury of PIP Joint →
	Jersey Finger (FDP Avulsion) Adult Operative	Wrist and Hand	Temporary finger splint in a comfortable position while awaiting hand-surgery evaluation.	No forceful gripping, pulling, or sport.
Motion Avoid resisted DIP flexion. Physical Therapy Postoperative hand therapy per repair protocol. Follow-Up / Imaging Urgent hand-surgery evaluation, ideally within days. Expected Bone Healing Tendon-to-bone healing generally requires several weeks after repair. Return to Work / School Modified duty until cleared. Return to Sports / High-Risk Activity Return after repair healing and functional rehabilitation, commonly several months. Hardware Removal Per surgical fixation. Bone Doc Pearl A jersey finger is usually a surgical injury, not a sprain to watch casually. Urgent Referral / Red Flags Open injury, displaced bony avulsion, retracted tendon, neurovascular compromise. Clinical Notes Loss of active DIP flexion after forced finger extension is a tendon avulsion until proven otherwise. Full Patient Page Jersey Finger (FDP Avulsion) →
	Central Slip Injury / Early Boutonnière Adult Nonoperative	Wrist and Hand	Continuous PIP extension splinting with the DIP free, often 6 weeks for an acute closed injury.	Light hand use while protecting the PIP.
Motion Actively flex the DIP while maintaining PIP extension; no unprotected PIP flexion initially. Physical Therapy Hand therapy is strongly helpful for splint fit and tendon-gliding program. Follow-Up / Imaging Early follow-up in 1–2 weeks; reassess extension and deformity progression. Expected Bone Healing Soft-tissue healing commonly 6–8 weeks. Return to Work / School Modified work as needed. Return to Sports / High-Risk Activity Return when extension is maintained and sport-specific function is restored. Hardware Removal If operative, per fixation. Bone Doc Pearl PIP extension must be protected while the DIP keeps moving. Urgent Referral / Red Flags Open injury, displaced avulsion, unstable joint, or inability to maintain PIP extension. Clinical Notes A central slip injury can look minor early and declare itself later as a boutonnière deformity. Full Patient Page Central Slip Injury / Early Boutonnière →
	Stable Proximal Phalanx Fracture Adult Nonoperative	Wrist and Hand	Buddy tape or radial/ulnar gutter splint based on digit and fracture stability, usually about 3 weeks.	No heavy lifting or forceful gripping until clinical healing.
Motion Begin early protected motion once stability is confirmed, often within the first 1–2 weeks. Physical Therapy Hand therapy if stiffness, edema, or tendon adhesion develops. Follow-Up / Imaging Alignment check in about 1 week; additional follow-up based on stability. Expected Bone Healing Approximately 4–6 weeks. Return to Work / School Desk/school early; heavy work after union and functional grip return. Return to Sports / High-Risk Activity Often 6–8 weeks or later depending on sport and tenderness. Bone Doc Pearl Rotation is less tolerated than modest angulation. Urgent Referral / Red Flags Any rotational deformity, open fracture, unstable pattern, intra-articular displacement, tendon injury, or neurovascular deficit. Clinical Notes Examine the finger cascade and nail alignment with active flexion. Full Patient Page Stable Proximal Phalanx Fracture →
	Metacarpal Neck Fracture (Boxer’s Fracture) Adult Nonoperative	Wrist and Hand	Ulnar-gutter splint or functional brace with MCP joints flexed, generally 3–4 weeks for a stable fracture.	Light use only; avoid punching, impact, and heavy grip.
Motion Keep IP joints moving; begin protected MCP motion when stable. Physical Therapy Hand therapy if stiffness or loss of function develops. Follow-Up / Imaging Recheck alignment and rotation in about 1 week. Expected Bone Healing About 4–6 weeks. Return to Work / School Desk work early; manual labor after painless grip and healing. Return to Sports / High-Risk Activity Usually 6–8 weeks; longer for contact sports. Bone Doc Pearl Look at the finger cascade before accepting the X-ray. Urgent Referral / Red Flags Malrotation, open fight-bite wound, significant shortening, unstable reduction, intra-articular extension, or neurovascular deficit. Clinical Notes Acceptable angulation depends on the metacarpal, but clinical rotation must be absent. Full Patient Page Metacarpal Neck Fracture (Boxer’s Fracture) →
	Bennett Fracture of Thumb Metacarpal Base Adult Variable	Wrist and Hand	Thumb-spica splint after reduction; definitive treatment depends on displacement and joint stability.	No gripping, pinching, or thumb loading.
Motion Maintain motion of uninvolved digits; thumb motion per definitive plan. Physical Therapy Hand therapy after stable fixation or immobilization. Follow-Up / Imaging Prompt hand-surgery review, generally within several days. Expected Bone Healing Typically 6 weeks or longer. Return to Work / School Modified duty until stable union and functional pinch return. Return to Sports / High-Risk Activity Usually several months for contact or high-demand sport. Hardware Removal Pins or hardware per fixation method. Bone Doc Pearl A reduced Bennett fracture must also be stable. Urgent Referral / Red Flags Irreducible or unstable reduction, articular displacement, open injury, or neurovascular compromise. Clinical Notes The deforming pull of the APL makes displaced Bennett fractures prone to redisplacement. Full Patient Page Bennett Fracture of Thumb Metacarpal Base →
	Thumb UCL Injury (Skier’s / Gamekeeper’s Thumb) Adult Variable	Wrist and Hand	Thumb-spica splint or cast. Stable partial injuries are commonly protected 4–6 weeks; complete displaced tears may require repair.	No pinch, gripping, or valgus stress at the thumb MCP.
Motion Motion begins after the protection phase for stable injuries or per repair protocol. Physical Therapy Hand therapy for motion and pinch recovery. Follow-Up / Imaging Early review after swelling improves; prompt hand referral if complete tear suspected. Expected Bone Healing Ligament healing commonly 6 weeks or more. Return to Work / School Modified work avoiding pinch. Return to Sports / High-Risk Activity Return when painless stable pinch and sport-specific function return, often 8–12+ weeks. Hardware Removal Per repair. Bone Doc Pearl A complete unstable UCL tear is not just a thumb sprain. Urgent Referral / Red Flags Marked laxity without endpoint, displaced avulsion, suspected Stener lesion, open injury, or neurovascular deficit. Clinical Notes A Stener lesion prevents the ligament from healing in its normal position. Full Patient Page Thumb UCL Injury (Skier’s / Gamekeeper’s Thumb) →
	Suspected Occult Scaphoid Fracture Adult Variable	Wrist and Hand	Thumb-spica splint or short-arm wrist immobilization while diagnosis is clarified.	No lifting, pushing, pulling, or impact through the wrist.
Motion Finger motion encouraged; wrist motion deferred until fracture excluded. Physical Therapy Usually not initially required. Follow-Up / Imaging Reassessment in 7–14 days or earlier MRI-based pathway. Expected Bone Healing If confirmed, healing varies by location and displacement, often 6–12+ weeks. Return to Work / School Modified duty while immobilized. Return to Sports / High-Risk Activity Return after confirmed healing, painless motion, and strength restoration. Hardware Removal If operative, per fixation. Bone Doc Pearl Normal initial X-rays do not rule out a scaphoid fracture. Urgent Referral / Red Flags Open injury, displacement, proximal pole fracture, perilunate injury, neurovascular deficit, or concerning swelling. Clinical Notes Proximal pole injuries and displacement have greater nonunion and avascular-necrosis risk. Full Patient Page Suspected Occult Scaphoid Fracture →
	Triquetral Dorsal Chip Fracture Adult Nonoperative	Wrist and Hand	Wrist splint for comfort, commonly 2–4 weeks.	Use as tolerated for light activity; avoid heavy loading until pain improves.
Motion Begin wrist motion as pain permits. Physical Therapy Usually not required; consider therapy for persistent stiffness. Follow-Up / Imaging Clinical follow-up in 2–4 weeks if symptoms persist. Expected Bone Healing About 4–6 weeks. Return to Work / School Work as comfort permits with temporary lifting restriction. Return to Sports / High-Risk Activity Typically 6–8 weeks when painless. Bone Doc Pearl The chip is often less important than the injury that created it. Urgent Referral / Red Flags Persistent ulnar-sided pain, instability, neurovascular findings, or high-energy mechanism. Clinical Notes Evaluate for associated carpal or ligament injury when pain is disproportionate. Full Patient Page Triquetral Dorsal Chip Fracture →
	Lesser Toe Phalanx Fracture Adult Nonoperative	Foot	Buddy tape to adjacent toe and rigid-sole shoe, generally 2–4 weeks.	Weight bearing as tolerated in protective footwear.
Motion Toe motion as pain allows after early protection. Physical Therapy Usually not required. Follow-Up / Imaging Follow up as needed; earlier for displacement or skin concerns. Expected Bone Healing Approximately 4–6 weeks. Return to Work / School Return to work/school as footwear and pain allow. Return to Sports / High-Risk Activity Usually 4–6 weeks when able to run, cut, and push off without pain. Bone Doc Pearl Most lesser-toe fractures need comfort and alignment—not a cast. Urgent Referral / Red Flags Open fracture, significant rotation, irreducible displacement, vascular compromise, or physeal concern. Clinical Notes Check rotation, nail bed, and skin; protect tape with padding. Full Patient Page Lesser Toe Phalanx Fracture →
	Great Toe Phalanx Fracture Adult Variable	Foot	Rigid-sole shoe or boot; consider more rigid immobilization for proximal or intra-articular injuries.	Weight bearing as tolerated if stable, with protection.
Motion Begin motion after early pain decreases when stability permits. Physical Therapy Usually not required; therapy for persistent stiffness. Follow-Up / Imaging Follow up in 1–2 weeks for displaced, proximal, or intra-articular patterns. Expected Bone Healing Approximately 6 weeks, sometimes longer. Return to Work / School Work based on footwear and push-off demands. Return to Sports / High-Risk Activity Return after painless push-off and near-normal motion, often 6–8+ weeks. Hardware Removal If operative, per fixation. Bone Doc Pearl Treat the great toe as a functional joint, not just another toe. Urgent Referral / Red Flags Open injury, displacement, significant articular involvement, instability, or neurovascular deficit. Clinical Notes The great toe is important for balance and push-off, so alignment matters more than in the lesser toes. Full Patient Page Great Toe Phalanx Fracture →
	Fifth Metatarsal Base Avulsion Fracture (Zone 1) Adult Nonoperative	Foot	Walking boot, hard-sole shoe, or supportive shoe for comfort, commonly 2–4 weeks.	Weight bearing as tolerated based on pain.
Motion Begin ankle and foot motion as comfort allows. Physical Therapy Usually not required. Follow-Up / Imaging Clinical follow-up in 3–6 weeks if symptoms persist. Expected Bone Healing About 6–8 weeks, though the line may remain visible longer. Return to Work / School Work as footwear and pain permit. Return to Sports / High-Risk Activity Return when hopping, cutting, and push-off are painless, often 6–8 weeks. Bone Doc Pearl Zone 1 usually behaves very differently from a Jones fracture. Urgent Referral / Red Flags Open injury, skin tenting, marked displacement, or concern for more proximal Zone 2 injury. Clinical Notes A small persistent radiographic fragment does not always mean failed healing if the patient is asymptomatic. Full Patient Page Fifth Metatarsal Base Avulsion Fracture (Zone 1) →
	Jones Fracture (Fifth Metatarsal Zone 2) Adult Variable	Foot	Short-leg cast or boot; nonoperative care often begins with strict protection and non-weight bearing.	Typically non-weight bearing initially; progression depends on symptoms and radiographic healing.
Motion Ankle motion may begin when allowed, while avoiding forefoot loading. Physical Therapy Therapy after healing if weakness or stiffness persists. Follow-Up / Imaging Early orthopedic follow-up, then serial review through union. Expected Bone Healing Often 8–12+ weeks; delayed union is common. Return to Work / School Modified duty; heavy labor after healing and strength recovery. Return to Sports / High-Risk Activity Return to sport only after clinical and radiographic union; operative fixation is often considered for high-demand athletes. Hardware Removal Intramedullary screw removal is not routine. Bone Doc Pearl Do not manage a true Jones fracture like a simple fifth-metatarsal avulsion. Urgent Referral / Red Flags Displacement, high-demand athlete, delayed union, refracture, open injury, or neurovascular compromise. Clinical Notes This fracture occurs in a vascular watershed region and has greater delayed-union/nonunion risk. Full Patient Page Jones Fracture (Fifth Metatarsal Zone 2) →
	Fifth Metatarsal Stress Fracture (Zone 3) Adult Variable	Foot	Boot or cast with strict activity modification; surgery is often considered for high-risk morphology or athletes.	Protected or non-weight bearing depending on symptoms and imaging.
Motion Maintain nonpainful ankle motion; no impact loading. Physical Therapy Progressive rehabilitation after evidence of healing; address training errors and bone health. Follow-Up / Imaging Close orthopedic follow-up. Expected Bone Healing Often prolonged—12 weeks or more. Return to Work / School Modified duty based on loading demands. Return to Sports / High-Risk Activity Return only after healing and graduated impact progression. Hardware Removal Not routine unless symptomatic after surgery. Bone Doc Pearl A Zone 3 stress fracture is a biology and mechanics problem, not merely an acute crack. Urgent Referral / Red Flags Completed fracture, sclerosis, delayed union, recurrent pain, high-demand athlete, or bone-health concern. Clinical Notes Look for cavovarus alignment, metabolic factors, and training-load errors. Full Patient Page Fifth Metatarsal Stress Fracture (Zone 3) →
	Stable Lisfranc Sprain / Nondisplaced Injury Adult Nonoperative	Foot	Short-leg cast or boot with strict immobilization, commonly at least 6 weeks if truly stable.	Non-weight bearing initially; gradual progression only after stability and symptoms are reassessed.
Motion Ankle motion may be allowed while protecting the midfoot; no forefoot twisting or push-off. Physical Therapy Rehabilitation after protection phase for gait, strength, and balance. Follow-Up / Imaging Early specialist review and repeat assessment after swelling decreases. Expected Bone Healing Often 8–12+ weeks; symptoms may persist longer. Return to Work / School Modified duty; prolonged restriction for standing or heavy labor. Return to Sports / High-Risk Activity Return after painless single-leg heel rise, push-off, and sport testing; often several months. Hardware Removal If operative, per fixation and surgeon preference. Bone Doc Pearl Plantar bruising and midfoot pain deserve respect. Urgent Referral / Red Flags Any diastasis or instability, plantar ecchymosis, inability to bear weight, high-energy injury, skin threat, or neurovascular deficit. Clinical Notes A subtle Lisfranc injury may have normal non-weight-bearing films. Full Patient Page Stable Lisfranc Sprain / Nondisplaced Injury →
	Turf Toe Adult Variable	Foot	Rigid-sole shoe, taping, carbon insert, or boot depending on severity; protect against great-toe dorsiflexion.	Weight bearing based on grade and pain; severe injuries may require temporary non-weight bearing.
Motion Early controlled motion for mild injuries; delay dorsiflexion stress for higher-grade injuries. Physical Therapy Athletic rehabilitation for push-off, intrinsic strength, and gradual cutting progression. Follow-Up / Imaging Reassess within 1–2 weeks for moderate/severe injuries. Expected Bone Healing Variable: mild injuries weeks; severe injuries months. Return to Work / School Work based on walking and push-off tolerance. Return to Sports / High-Risk Activity Grade-dependent; return only when sprinting and cutting are painless and stable. Hardware Removal If operative, per repair. Bone Doc Pearl The ability to push off matters more than resting pain alone. Urgent Referral / Red Flags Instability, sesamoid retraction, fracture, severe swelling, inability to push off, or failed conservative care. Clinical Notes Loss of sesamoid position or plantar-plate integrity changes the injury from a simple sprain. Full Patient Page Turf Toe →
	Navicular Stress Fracture Adult Variable	Foot	Strict immobilization; commonly non-weight bearing cast or boot for a confirmed stress fracture.	Non-weight bearing during the initial healing phase.
Motion Maintain proximal conditioning without foot loading; no running or jumping. Physical Therapy Structured return-to-run program after healing; address biomechanics and bone health. Follow-Up / Imaging Close sports/foot-and-ankle follow-up. Expected Bone Healing Often 6–12+ weeks, depending on completeness and treatment. Return to Work / School Modified duty until protected walking is painless. Return to Sports / High-Risk Activity Return after clinical and imaging healing with graded impact progression, commonly several months. Hardware Removal If operative, per fixation. Bone Doc Pearl Dorsal navicular tenderness in an athlete should not be dismissed. Urgent Referral / Red Flags Completed fracture, displacement, sclerosis/cystic change, delayed diagnosis, high-level athlete, or metabolic bone concern. Clinical Notes Navicular stress fractures are high-risk because symptoms can be subtle and healing can be slow. Full Patient Page Navicular Stress Fracture →
	Stable Isolated Lateral Malleolus Fracture Adult Nonoperative	Leg and Ankle	Walking boot or short-leg cast depending on pain, swelling, and stability.	Weight bearing as tolerated if the ankle mortise is confirmed stable; otherwise protect until stability is established.
Motion Begin ankle motion when safe and swelling permits. Physical Therapy Home exercises or therapy for motion, gait, balance, and strength. Follow-Up / Imaging Early follow-up to confirm mortise stability; later review around 6 weeks. Expected Bone Healing Approximately 6 weeks. Return to Work / School Desk work early; standing/manual work based on gait and pain. Return to Sports / High-Risk Activity Typically 8–12 weeks when strength, balance, and impact tolerance return. Bone Doc Pearl A stable mortise can often mobilize earlier than the X-ray appearance suggests. Urgent Referral / Red Flags Medial tenderness or widening, displacement, syndesmotic injury, skin threat, open fracture, or neurovascular deficit. Clinical Notes The key decision is ankle stability, not simply whether the fibula is fractured. Full Patient Page Stable Isolated Lateral Malleolus Fracture →
	High Ankle Sprain / Syndesmotic Injury Adult Variable	Leg and Ankle	Boot or cast for stable injuries; unstable syndesmotic disruption requires fixation.	Protected weight bearing; severe injuries may begin non-weight bearing.
Motion Avoid external-rotation stress; begin controlled ankle motion as stability permits. Physical Therapy Progressive gait, calf, balance, and sport-specific rehabilitation. Follow-Up / Imaging Early reassessment; prolonged symptoms warrant specialist review. Expected Bone Healing Stable injuries often take 6–12 weeks; unstable injuries longer. Return to Work / School Modified duty based on walking tolerance. Return to Sports / High-Risk Activity Often longer than a routine lateral ankle sprain; return after pain-free cutting and external-rotation stress. Hardware Removal Syndesmotic screw removal is not universally routine; depends on construct and symptoms. Bone Doc Pearl Persistent pain above the ankle after a ‘sprain’ may signal syndesmotic injury. Urgent Referral / Red Flags Mortise widening, proximal fibular tenderness, inability to bear weight, deltoid injury, open injury, or neurovascular deficit. Clinical Notes Syndesmotic injuries usually recover more slowly than common lateral ankle sprains. Full Patient Page High Ankle Sprain / Syndesmotic Injury →
	Maisonneuve Injury Adult Variable	Leg and Ankle	Long-leg or short-leg immobilization depending on associated injury while awaiting definitive evaluation.	Non-weight bearing.
Motion No ankle loading; maintain toe motion. Physical Therapy Postoperative rehabilitation per fixation. Follow-Up / Imaging Urgent orthopedic evaluation. Expected Bone Healing Typically several months depending on syndesmotic injury and fixation. Return to Work / School Modified duty until stable healing and gait recovery. Return to Sports / High-Risk Activity Return after union, syndesmotic healing, and functional testing. Hardware Removal Per fixation. Bone Doc Pearl Always examine the entire fibula in a suspicious ankle injury. Urgent Referral / Red Flags Mortise widening, proximal fibula fracture with ankle pain, deltoid injury, open injury, skin threat, or neurovascular deficit. Clinical Notes The ankle injury may be more important than the proximal fibula fracture that draws attention. Full Patient Page Maisonneuve Injury →
	Acute Achilles Tendon Rupture Adult Variable	Leg and Ankle	Functional boot or cast in plantarflexion with heel wedges; treatment pathway individualized.	Early protected weight bearing is used in many functional protocols, but timing follows the selected pathway.
Motion Gradual progression toward neutral; avoid unprotected dorsiflexion early. Physical Therapy Structured functional rehabilitation is essential for both operative and nonoperative care. Follow-Up / Imaging Prompt orthopedic/sports evaluation and scheduled rehabilitation checks. Expected Bone Healing Tendon healing and rehabilitation occur over months. Return to Work / School Desk work early; standing/manual work individualized. Return to Sports / High-Risk Activity Running and sport commonly require 6–12 months depending on strength and function. Hardware Removal Per operative technique; routine removal uncommon. Bone Doc Pearl The rehab protocol is as important as the decision to operate. Urgent Referral / Red Flags Open rupture, skin compromise, delayed presentation, diagnostic uncertainty, or inability to follow a functional protocol. Clinical Notes Modern outcomes depend heavily on early functional rehabilitation and adherence. Full Patient Page Acute Achilles Tendon Rupture →

Abbreviation Key

Abbreviation	Meaning
NWB	No weight bearing
TDWB	Touch-down weight bearing
PWB	Partial weight bearing
WBAT	Weight bearing as tolerated
FWB	Full weight bearing
ROM	Range of motion
NRM	No resistance or strengthening
SAC	Short-arm cast
LAC	Long-arm cast
LAS	Long-arm splint
SLC	Short-leg cast
SLS	Short-leg splint
CAM boot	Controlled ankle motion boot
KI	Knee immobilizer
HKB	Hinged knee brace
ORIF	Open reduction and internal fixation
IMN	Intramedullary nail
HWR	Hardware removal
Fu	Follow-up
DC	Discontinue
PRN	As needed
XR	X-ray

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