Upper Extremity
Fracture Care
Jacksonville, FL
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.
- ED first: Bone through skin, open wound over fracture site
- ED first: Absent pulse, white or blue fingers after an injury
- Same day: Significant deformity or inability to use the limb
- Within days: Wrist or elbow fracture confirmed on X-ray
- Within days: Suspected scaphoid fracture — normal X-ray doesn't rule it out
- Scheduled: Finger fracture, non-displaced, no rotation
JOI Now walk-in orthopaedic care is available Monday–Friday for fractures that don't require emergency stabilization.
Upper Extremity Fracture Expertise
Every Fracture.
Fingertip to Shoulder.
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 Dr. Graham sees 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.
Open Fractures & Vascular Compromise
Bone through skin, open wound over a fracture, absent pulse, or white/blue fingers after an injury require emergency department stabilization before orthopaedic evaluation.
Significant Deformity or Instability
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.
Wrist, Elbow & Suspected Scaphoid
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.
Stable Finger & Hand Fractures
Non-displaced or minimally displaced finger and metacarpal fractures without rotation or significant shortening — scheduled evaluation for splinting and monitoring.
Malunion & Revision
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
Every Upper Extremity Fracture
Adult and pediatric fractures at every level — from fingertip to shoulder girdle. Purple badges indicate conditions with significant pediatric considerations.
Upper Extremity Fracture Expertise
Trauma Work Done Right
What separates good fracture care from excellent fracture care — in Dr. Graham's practice specifically.
A Mechanical Understanding Built Before Medicine
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.
Perfectionism That Shows on X-Ray
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.
The Full Spectrum — No Referral Needed
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.
Most Fractures Don't Need Surgery
A surgeon who operates on every fracture is not serving their patients well. The majority of fractures Dr. Graham sees 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.
Arthroscopic Assistance for the Wrist
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 — Don't Wait
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 Accepted
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.
Malunion & Revision — Second Chances
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.
“Everything was fully explained to me. Dr. Graham called me at home the evening of my surgery to see how I was doing. Ten weeks post surgery my wrist is back to normal.”
Common Questions