"Phisal gaye, haddi toh nahi tooti?" — fracture treatment Indore families ask about every monsoon

"Doctor sahab, mummy bathroom mein phisal gayin. Phisal gaye, haddi toh nahi tooti?"

I take this call several times a week once the rains begin, usually from a son or daughter, with the patient in the background insisting everyone is making a fuss. A fracture is a break in a bone, and in older adults it takes far less force than families expect — a slip from standing height is enough. Falls at that age are not a small category of accident: the World Health Organization reports an estimated 684 000 fatal falls each year, making falls "the second leading cause of unintentional injury deaths worldwide", with 37.3 million more each year severe enough to need medical attention, and adults over 60 suffering the greatest number of fatal falls.

Families want one thing from that call: whether this needs a doctor tonight, or can wait till morning. This is my honest answer.

Why the monsoon is fracture season in Indore

Monsoon turns ordinary household surfaces into the commonest cause of fractures I see. From the last week of June my OPD changes: younger patients from two-wheeler skids, older patients after falling inside their own homes, in the same four places. The US Centers for Disease Control and Prevention notes that "more than one out of four older people falls each year, but less than half tell their doctor" — so the first fall in a family often surfaces only when a bone breaks.

Polished floor tiles first: marble and vitrified tile behave like glass under a film of water, and all it takes is wet feet from the balcony. Bathrooms are worse — soap on water, nothing soft to land on, nothing to hold. Third is the step down from a shop into standing water, where you cannot see the depth before your weight is committed. Fourth is footwear: chappals worn three years have no tread left, and a smooth sole on wet mosaic gives no grip.

The three fractures that actually follow a fall after 60

A younger person who slips gets up with a bruise. After 60, three fractures account for nearly everything I treat from a household fall, and which one you get depends on how you land — hand out, sideways, or down onto the seat. Each has a different giveaway sign at home, and one is far more urgent than the others.

The wrist, from putting a hand out. Nobody can switch off that reflex, and the whole body weight lands on an outstretched palm. The break sits just above the wrist: sharp pain, fast swelling, turning the palm up and down very painful. People can still wiggle their fingers and assume that rules a fracture out. It does not.

The hip, from landing on the side. A sideways slip breaks the top of the thigh bone. The pain sits in the groin or upper thigh rather than over the bony point, the person cannot stand, and often the leg looks shorter with the foot rolled out. Being unable to lift that heel off the bed is a strong sign.

The spine, from landing hard on the seat. Sitting down heavily on a wet floor can compress a vertebra. The pain is in the back, worse standing and turning in bed, easier lying flat, with no bruise to see — so people carry these for weeks believing it is a muscle pull. Severe back pain after a fall deserves an X-ray, not a balm.

Phisal ke gir gaye — haddi tooti hai ya moch?

Often you cannot tell at home, and frequently I cannot either without a film. A bad sprain can swell and hurt more than a clean crack, and some fractures in thin bone are hairline, with the person walking in on their own leg. So do not diagnose — use a threshold, and assume fracture if any of these apply.

• They cannot bear weight, or cannot take four steps unaided.
• There is a visible deformity — a bend, a step, a limb not the shape of the other side; or the leg looks shorter and the foot turns out.
• Pressing one exact point on the bone gives sharp pain, unlike general soreness.
• Swelling or bruising appeared within minutes, or somebody heard a crack.
• Fingers or toes beyond the injury are numb, pale or cold — see someone immediately.
• They are over 60, or have thin bones, or take long-term steroids, and the pain is more than trivial. My threshold for an X-ray here is deliberately low, and yours should be too.

If none of that applies and they are walking and using the limb, resting overnight is reasonable. If it is no better next morning, get the X-ray anyway: an X-ray is cheap, a fracture that sets crooked is not.

The first hour: what never to do

The first hour after a fall is when most avoidable harm happens, and almost all of it comes from well-meant help — oil, a tight bandage, someone who "sets bones", and the reassurance of watching the person walk a few steps. Each makes a fracture harder to treat. Four things to avoid before the limb is seen.

No massage. Oil massage over a fresh injury is the commonest thing I have to undo: it increases bleeding into the tissue, worsens swelling and pain, and does nothing for the bone.

No pulling, and no "setting" it. Do not let an untrained person manipulate the limb, however confident they are. I have seen a simple wrist fracture turned into a badly displaced one this way. Repositioning a bone is done with imaging and pain relief.

No hot compress or balm on a fresh injury — warmth belongs to old stiffness. Do not make them walk to test it, and do not tie a splint tightly; if fingers or toes go cold or blue, loosen it.

A hip fracture is not something to watch overnight

If you read nothing else here, read this. When an older person falls, cannot stand and has pain in the groin or upper thigh, treat it as a hip fracture until an X-ray says otherwise — that evening, not tomorrow. The NHS is equally direct: "A broken hip (hip fracture) is serious and needs treatment in hospital straight away." Its guidance on a broken hip adds that most people need surgery, usually the same day or the day after reaching hospital.

"If an older person falls, cannot stand and the pain is in the groin or upper thigh, treat it as a hip fracture until an X-ray says otherwise — that evening, not the next morning. Waiting helps nothing; early surgery is what lowers the complications." — Dr. Arpit Maurya, MBBS, MS (Orthopaedics)

The hurry is not only the bone. A hip fracture is a serious general illness: the StatPearls hip fracture review on the NIH's Bookshelf records that "mortality rates are reported to be between 18% to 31% within 1 year", and that only 40% to 60% of patients regain their baseline mobility.

Waiting has a measurable cost. A systematic review held on the NIH Bookshelf found early surgery — within 24 to 72 hours — "was associated with a 19% reduction in all-cause mortality", a 41% reduction in pneumonia and a 52% reduction in pressure sores, holding after accounting for how fit patients were beforehand. Days lying flat bring exactly those complications, plus clots, confusion and muscle loss. What a joint replacement involves covers the surgical side.

Some hip fractures are impacted: the person wobbles a few steps and insists she is fine. A groin that hurts after a fall gets an X-ray anyway.

Ghar pe abhi kya karein — what to do at home right now

• Look before you lift. Ask where it hurts before helping them up. If the answer is hip, groin or back and they cannot stand, leave them there and arrange transport.
• Support the part in the position that hurts least — for a forearm, a rolled newspaper either side wrapped with cloth, resting in a dupatta sling; for a leg, a pillow each side.
• Remove rings and bangles now, before swelling makes it impossible.
• Ice wrapped in cloth, ten to fifteen minutes at a time, never on bare skin, and raise a wrist or ankle on a pillow.
• Paracetamol is reasonable meanwhile, and keep food light in case an operation is needed.
• Write down what happened — the time, how they fell, whether they blacked out first, and their regular medicines.

Red Flags — Ghar ka ilaaj kaafi nahi hai

Aa jaiye — agar: they cannot stand or take a few steps; there is pain in the groin, hip or thigh; one leg looks shorter or the foot turns outward; a limb looks bent; fingers or toes are numb, cold or blue; there is a wound over the injury, which needs immediate attention; they lost consciousness or take blood thinners; there is severe back pain or difficulty passing urine; or you are unsure.

Preventing the next one: bathroom, doorway and chappals

Preventing the next fall is cheaper than treating it, and most falls I see were preventable for under a thousand rupees. It is more urgent than families realise, because the CDC points out that "falling once doubles your chances of falling again" — so the slip that did no damage this week is a warning, not a lucky escape.

The bathroom. An anti-skid mat where they stand, a grab bar beside the WC and in the bathing area, and a plastic stool so they sit to bathe. The doorway. Wipe the entrance each evening where umbrellas and wet feet arrive, use an absorbent mat rather than a thin plastic one, and paint the edge of any step a contrasting colour. Light. A night lamp on the route to the bathroom. Chappals. Replace any smooth sole — real tread, back strap, low heel. Clear the floor of loose rugs and wires.

Check the person too: cataract, dizziness on standing, and some blood pressure and sleep medicines all cause falls — as do stiff knees, covered in why joints hurt more in the monsoon.

Fracture treatment Indore: what happens when you bring them in

I ask exactly how the fall happened, examine the limb, check circulation and sensation beyond the injury, and X-ray in the right views. Some hairline fractures, particularly in the hip, do not show on a first film — so if the story and examination point one way and the film looks clean, we repeat it rather than sending you home. Undisplaced fractures go into a cast or splint with follow-up; displaced ones need a surgical discussion.

If someone at home has fallen this week and you are unsure, message us on WhatsApp, call 7869709075, or book an evening slot at drhealthcare.in, Monday to Saturday, 6 to 8 PM. Please do not buy a painkiller strip and wait — why self-medication goes wrong explains what that hides.

The question worth asking after the fracture heals

An adult with healthy bone who slips from standing height usually bruises. When the same fall breaks a wrist, hip or vertebra after 60, the fall is often not the whole story — the bone was already thin, and the slip revealed it. The CDC's figures make the link plain: in 2019, 88% of emergency department visits and hospitalisations for hip fractures were caused by falls.

Bone loss does not hurt and gives no warning, so the fracture is often the first evidence of it. Once things have healed, come back for a conversation about bone health: a density scan where appropriate, a vitamin D and calcium check, and balance work. Treating the fracture is the urgent job; asking why the bone gave way stops next year repeating this one.

Questions patients ask us