Physicians need to refresh their skills in commonly occurring injuries. In many places, subspecialist help is not available or affordable. These basic skills reflect the reality of community medical practice for a variety of specialties staffing rural emergency rooms, primary care offices, and mission hospitals. For younger physicians, academic medicine teaches a curriculum of “Refer to Ortho.” Many fractures can be managed conservatively while maintaining quality in the community. The trick is to know which ones require surgery.