Complex Fracture (Broken Bone) Care

Duke Health orthopaedic surgeons specialize in complex fractures, including painful fractures that don’t heal correctly, fractures that cause bone loss or deformity, and fractures that cause tissue damage, leading to open wounds. Our goal is to heal your fracture, increase your stability, enhance your function, and improve your quality of life.

About Complex Fractures

Nonunions are fractures that don't heal. They can be very painful.
Malunions are fractures that heal crooked. They can cause issues with movement and put you at risk of arthritis.
Fractures can result in bone loss. Portions of bone may be missing or stripped of their blood supply.
Fractures can cause a deformity or limb shortening
Fractures may be accompanied by soft tissue damage, such as skin or muscle problems, or open wounds.

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Diagnosing Complex Fractures

Your doctor will perform a comprehensive evaluation to understand why your fracture hasn’t healed properly in order to inform your treatment plan.

Physical Exam

Your surgeon will ask you questions and conduct a physical exam to learn about the functional issues of your limb.

X-rays

X-rays will help your doctor understand why your bone may not have healed properly.

CT Scans

CT scans can provide even further detailed information about bone alignment and bone integrity, as well as healing potential.

Lab Work

Bloodwork provides insight into your overall bone health as well as provides information about any infection that may be present.

Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.

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Treating Complex Fractures

Complex fractures may not be completely fixed in a single surgery. They often require a treatment plan that includes a team of specialists. Duke orthopaedic surgeons use a variety of techniques and technologies to reconstruct limbs and heal problem fractures. We monitor your progress through consistent follow-up visits and imaging.

Osteotomy

During an osteotomy, your surgeon relieves pain and corrects deformities by cutting or reshaping the bone. Pins, plates, and screws hold the bone in the corrected position while it heals.

Internal and External Fixators

Duke orthopaedic surgeons use hardware to create support and restore stability to bone. Internal fixators consist of plates, screws, rods, nails, pins, and wires placed inside your body. External fixators are pins and wires placed into the bone and connected to a frame outside your body.

Bone Transport

In a bone transport, new bone is grown to fill a gap that is present in the fracture, or that the surgeon has created. The surgeon cuts bone near the gap, and attaches internal or external fixators that gradually move the bone to fill the gap. The new bone grows approximately one millimeter per day, fuses with existing bone, and hardens over time.

Bone Graft

During a bone graft, a donated piece of bone helps repair a fracture, fuse bones, or fill in gaps in the bone caused by cysts or tumors. The bone may come from your body or from a donor’s body or be of a synthetic material. After the surgeon implants the bone, your own bone cells begin to grow and eventually replace the graft.

Best Orthopaedic Hospital in North Carolina

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our orthopaedics program is nationally ranked and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2025–2026.

Why Choose Duke

Infection Care

Infection is common with complex fractures. Our infectious disease doctors work closely with our pathologists to correctly identify sources of infection, and with our orthopaedic surgeons to coordinate treatment.

Vast Experience in Treating Fractures

Duke has the infrastructure, expertise, and resources to treat the most challenging complex fracture issues. We do more of these procedures than most hospitals across the country.

Advanced Technologies

We use 3D surgical planning to map the defect and desired alignment, and robotic-assisted corrections and fixation for planned, accurate surgical placement of components. When appropriate, we use custom 3D-printed implants, cages, reconstruction devices.

A Team-Based Approach

Complex fractures may be associated with multiple issues. Our team includes work alongside plastic surgeons, infectious disease doctors, wound management specialists, and physical and occupational therapists to provide you with full-spectrum treatment.

Robust Research Program

Duke orthopaedic researchers are investigating solutions to prevent complex fractures and prevent infection, to improve healing, and to regenerate bone after injury.

This page was medically reviewed on 02/13/2026 by

Malcolm DeBaun, MD | Orthopaedic Trauma Surgeon