The development in imaging and operative fixation of fractures has improved the care and prognosis of fractures during last 20 years. These have benefitted the affluent nations most. The rigid fixation of the fractures encourages formation of a weak callus, atrophies the underline bone and increases the rate of re-fracture after removal of fixation. The high success can be obtained with casts and braces that allow motion of adjacent joints. Any treatment modality requires a clear understanding of its philosophy as well as appropriate technical details. Non-operative treatment of fracture is free of complications that frequently accompany internal fixation such as infection, nerve injury, synostosis and nonunion. Up to 8° of angular deformity can be accepted in tibia or femur. Humerus seems to tolerate angular deformities best. The understanding of close management of fractures is important to achieve best clinical results. The arthritic changes that occur with intra-articular fractures are the result of damage to cartilage during injury. The articular cartilage has the ability to overcome relatively minor post traumatic incongruities and quite often the arthritic changes as a reflection of permanent damage to articular cartilage are not associated with clinical symptoms. Even surgery performed for reposition of the intra-articular fragments is associated with delay in regaining motions of the operated joint. If the orthopaedics surgeon providing fracture care is appropriately educated and infrastructure of the hospital is advanced surgical treatment may be superior in many instances. However if proper environment does not exist the ultimate results of surgery may be catastrophic.