Quiz: External Coaptation vs Surgical Fixation for Bone Fractures

When treating fractures, clinicians must decide whether to recommend surgical fixation or external coaptation via a cast or splint. Indications for splinting or casting include stable, closed fractures distal to the knee and elbow joints.

Although external coaptation is often inexpensive and noninvasive, it can be misused as the main treatment for fractures.¹ Potential complications include soft tissue injury; malunion, delayed union, or nonunion; and comorbid diseases or conditions associated with joint stiffness, muscle atrophy, and/or osteopenia from disuse. Incorrect treatment selection can also lead to complications. Open or unstable fractures, especially those involving the humerus or femur, should not be casted or splinted as a sole means of management.

Surgical intervention can be beneficial, as it allows for strong fixation and appropriate reduction. However, surgery has a higher initial cost and an associated risk for anesthetic complication, infection, implant failure, and poor bone healing following surgical trauma, leading to malunion, delayed union, or nonunion.² In addition, postoperative external coaptation may introduce additional complications.

This quiz addresses common fracture cases and appropriate treatment options.