“treatment outside of the ranch” would likely be the initial x-ray, and setting the cast.
The treatment he would be doing at the ranch would then be follow-up visits, as the ranch physician.
My insurance company works like this. I have to get treatment for broken bones at the hospital, then I can do followup with my primary care physician.
This probably means they don’t have the facilities at the ranch for x-rays.
So, these outside facilities should have record of the broken bone cases, to match the 41 incidents of broken bones.