Complex Fracture Management

Complex Fracture Management

Complex fracture patients are cared for by several types of specialists who provide unique expertise for these injuries. Our team approach ensures that you receive the best possible treatment through the use of cutting edge diagnostic tools combined with advanced soft tissue and bone reconstruction techniques. Imaging like 3D CT scans and digital tomography provide the best possible view of the fracture when planning for treatment. 3D imaging is being used at Penn to create custom 3D printed implants for patients with challenging reconstructions.  Penn surgeons also use advanced reconstruction techniques beyond standard plates, screws and rods for highly complex patients.

Complex Fracture Care at Penn includes

  • Advanced 3D imaging for superior visualization
  • 3D printed, custom fracture solutions
  • Coordinated plan for soft tissue and bone reconstruction
  • Ring fixation which is less invasive and has less risk for infection long term
  • Dynamic fixation for fractures that require more flexibility for optimal recovery
  • Implants impregnated with antibiotics for patients at high risk of infection
  • Optimized bone growth by using biologics and the Masquelet technique which promote healing

A treatment strategy may include a range of options including

  • Fracture fixation: A fracture fixation is a surgical procedure that stabilizes the affected limb, preparing for transfer or reconstruction.
  • Debridement: Removal of dead tissue which is necessary for proper wound healing.
  • Soft tissue coverage: Soft tissue coverage comes mostly from the patient’s own tissue. Surgeons use local tissue and grafts – usually taking a much smaller amount of skin or tissue than previously required to cover injuries.
  • Revascularization: In cases of severe trauma, blood flow to affected tissues can be compromised resulting in necrosis–death of body tissue. Early treatment is critical. Using microvascular techniques, the Penn team is able to restore blood flow to the affected area and avoid amputation or more severe debridement (removal of damaged tissue).
  • Fracture reconstruction: Surgery to fix a broken bone typically using metal screws, rods, or plates to hold the bone in place as it heals. In addition to traditional screws, Penn also uses state-of-the-art dynamic screws and plates for fractures in locations that require more flexibility for optimal healing. Penn also utilizes 3D printed implants for custom reconstruction.

Complex fractures exhibit certain characteristics which may include

  • Soft tissue damage
  • Severe cartilage injury to joint
  • Bone loss due to severe trauma
  • Presence of multiple fractures in a single bone
  • Comminuted bone fragments (broken into many pieces)
  • Associated joint dislocation

These types of injury require timely specialist care aimed at preserving life and limb whilst achieving an optimum functional outcome and continued quality of life for the injured patient.

To promote the best outcome for patients who sustain such severe injuries trauma networks and hospitals require the appropriate pathways and infrastructure in place to minimise complications and enable optimum recovery.

To promote the provision of quality, evidence based care 


Complex fractures exhibit certain characteristics, which set them apart from normal fractures and help in classifying the extent of the injury. When examining a complex fracture, orthopedic surgeons like Dr. Allison assess damage based on the following:

  • Soft tissue damage
  • Severe cartilage injury to joints
  • Bone loss due to severe trauma
  • Presence of multiple fractures in a single bone
  • Comminuted bone fragments (broken into many pieces)
  • Associated joint dislocation

Most complex fractures are open with complete fractures and patients experience symptoms including protruding bones, extreme pain of the affected part, and numbness.

Immediate treatment is often required once the surgeon has completed the physical examination. For patients with an “open fracture,” wounds are first cleaned up and infection prevented before X-rays and possibly an MRI is taken for additional information then the patient goes into surgery.