Fracture care begins when a fracture is treated. Either closed, open etc. For instance, if a patient has a closed fracture of the femur and the date of injury is 01/01/2015. However, because of other issues, the patient's fracture is not treated until 02/01/2015, if the doc puts a splint, or treats with plates & screws, IM nailing,perc. pinning, etc... fracture care begins on 2-1-2015 and the patient will be in a global until 5/2/15 (Since that is 90 days from beginning of treatment). When the orthopod sees the patient, and determines how best to treat the fracture, that is when fracture care begins. Even though he may not be able to assess the patient's fracture perhaps for weeks after the initial injury, if he decides to treat the fracture with plates & screws, splint only, perc. pinning, etc..... His global days begin the day the fracture is treated, no matter the date of injury.