Every fracture of the hand, wrist, forearm, elbow, and shoulder — adult and pediatric, open fractures, complex intra-articular patterns, malunion, and revision. Most fractures are managed without surgery. When surgery is needed, Dr. Graham delivers results he takes pride in.
JOI Now walk-in orthopaedic care is available on clinic days for fractures that don't require emergency stabilization.
Upper Extremity Fracture Expertise
There is not a fracture of the upper extremity that Dr. Graham doesn't treat. Finger fractures that look simple but are rotated. Wrist fractures in 80-year-olds with osteoporotic bone that won't hold a plate. Pediatric distal radius physeal injuries where respecting the growth plate matters. Distal humerus fractures in older patients where arthroplasty outperforms fixation. Open fractures. Malunions. Revision fixation after hardware failure. All of it is in scope.
Long before medical school, Dr. Graham was already taking things apart to understand how they worked — replacing the rear main seal on his car, rebuilding the evaporator coil on his home AC unit, building a home addition from the ground up. That background is not incidental to his surgical practice. It is the foundation of it. When he encounters a complex fracture pattern, he approaches it the way he approached every mechanical problem before surgery: learn how it failed, understand the forces acting on it, find the right method to restore it, and execute that method precisely.
Fracture surgery is a mechanical problem. Bone fails according to predictable physical laws. Fragments displace in patterns that reflect the direction and magnitude of the injuring force. Hardware interacts with bone under load in ways that either protect the repair or doom it. Surgeons who understand these mechanics — not just the steps of the procedure — make better decisions intraoperatively, choose better fixation constructs, and avoid the compromises that produce mediocre post-operative X-rays.
The perfectionism compounds this. A millimeter of articular step-off is visible on a post-operative film. A plate that sits slightly proud, a screw 2mm too long, a reduction that accepted a degree of malrotation — these appear on follow-up X-rays and they appear in patient outcomes. Dr. Graham does not accept "good enough" in the operating room, and his post-operative films reflect that standard. Patients heal the way their X-rays look.
At the same time, being a surgeon doesn't mean operating on every fracture. The majority of upper extremity fractures seen in this practice are managed non-operatively. A boxer's fracture that is acceptably aligned doesn't need a plate. A minimally displaced distal radius in a low-demand patient heals reliably in a cast. The standard is simple: operate when the evidence says it matters for the outcome, and not otherwise.
Bone through skin, open wound over a fracture, absent pulse, or white/blue fingers after an injury require emergency department stabilization before orthopaedic evaluation.
Obvious deformity, inability to use the limb, or a fracture that was reduced in the ED and needs orthopaedic follow-up — same day when possible.
Distal radius fractures, elbow fractures, and any wrist injury where scaphoid fracture is possible — even with normal X-rays. MRI or CT confirms; early diagnosis prevents nonunion.
Non-displaced or minimally displaced finger and metacarpal fractures without rotation or significant shortening — scheduled evaluation for splinting and monitoring.
Fracture healed in a poor position, hardware failure, or unsatisfactory result from prior surgery — formal evaluation and surgical planning as a scheduled consultation.
Fractures by Region
Adult and pediatric fractures at every level — from fingertip to shoulder girdle. Purple badges indicate conditions with significant pediatric considerations.
Upper Extremity Fracture Expertise
What separates good fracture care from excellent fracture care — in Dr. Graham's practice specifically.
Before medical school, Dr. Graham was already rebuilding car engines, replacing home AC units, and building additions onto houses — taking things apart to understand how they worked, then putting them back together correctly. That mechanical foundation shapes how he approaches every fracture: understand the failure, plan the reconstruction, execute it precisely. Fracture surgery rewards exactly this kind of thinking.
A millimeter of articular step-off is visible on a post-operative film. A plate that sits slightly proud, a screw 2mm too long, a reduction that accepted a degree of malrotation — these appear on follow-up X-rays and they appear in patient outcomes. Dr. Graham does not accept "good enough" in the operating room. The standard is anatomic reduction, stable fixation, and a post-operative film that reflects the work. Patients heal the way their X-rays look.
Every fracture of the upper extremity is within scope — finger through clavicle, adult and pediatric, open, malunion, and revision. There is no fracture pattern referred out because it's too complex. One surgeon, one practice, the whole extremity.
A surgeon who operates on every fracture is not serving their patients well. The majority of fractures seen in this practice are managed non-operatively — casting, splinting, functional bracing, and close follow-up. Surgery is recommended when the evidence says it improves outcomes, and not otherwise. Patients trust this approach because it's honest.
For select intra-articular distal radius fractures, Dr. Graham uses wrist arthroscopy to directly verify articular reduction — confirming joint surface congruence that fluoroscopy alone cannot reliably demonstrate. A 1mm step-off that looks acceptable on X-ray is visible under the scope. This level of precision matters for long-term outcomes, particularly in younger, more active patients.
Scaphoid fractures are missed on initial X-ray in up to 20% of cases. A wrist injury with anatomical snuffbox tenderness and normal films is a suspected scaphoid fracture until MRI or CT proves otherwise. Untreated, they progress to nonunion and SNAC arthritis — a cascade entirely preventable with early diagnosis and appropriate treatment.
Open fractures require urgent irrigation, debridement, and fracture stabilization. Dr. Graham accepts open upper extremity fractures and coordinates with the emergency department for initial stabilization before definitive surgical management. Timing, soft tissue handling, and fracture stability are all critical variables.
A fracture that healed badly is not the end of the story. Corrective osteotomy at the wrist, forearm, hand, and elbow can restore function patients thought was permanently lost. In Dr. Graham's experience, many patients referred for malunion were told nothing more could be done. That is rarely true.
"Pauline Hartje had a complex 4-part wrist fracture. Dr. Graham called the next morning to check in, and the scar was essentially invisible."
Pauline Hartje · Wrist Fracture Patient · Verified Google Review ★ 5/5
Common Questions