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Comminuted Fracture

Definition

A comminuted fracture is the type of fracture in which the bone has been broken into pieces. If the bone has been crushed or broken into smaller splints, this is also a comminuted fracture. Doctors call a comminuted fracture as the one in which the bone has broken in three or more than three pieces.


Symptoms of Comminuted Fracture

These are the symptoms of the comminuted fracture:

  • Intense pain in the fractured area
  • The pain is due to the following changes:
    • The continuity of the periosteum (protective sheath of the bone) has been breached
    • The vascular tissue has been involved in the fracture
    • The hemorrhage occurring to the fracture leads to the inflammation of the surrounding tissues
    • The pain is induced by the numerous pain receptors being activated all of a sudden
    • The muscles enter in a state of rigidity, trying to keep the bone into place, which causes even more pain
  • The pain can be so intense that the patient will lose consciousness
  • The area in which the fracture has occurred can be marked by severe swelling
  • Due to the circulatory changes occurring with the fracture, the area might appear pale in color and warm to the touch
  • Upon palpation, the patient might present tenderness and pain
  • The skin in the area of the fracture appears bruised
  • If the fracture is more severe, the limb might be in an abnormal position or a part of the bone might actually puncture the skin, sticking out

Causes

These are the most common causes that can lead to the appearance of a comminuted fracture:

  • Car accidents
  • Falling from a considerable height
  • Gunshot wounds
  • Contact sports – a tackle during a football game can lead to the appearance of a comminuted fracture
  • The overuse of the bones – this often happens in those who perform repetitive motions (these are known as stress fractures and they are quite common in professional athletes)
  • Aging – with aging comes osteoporosis (especially in women), which increases the fragility of the bones and the risk for comminuted fractures
  • Different diseases of the bone
  • Chronic smoking is considered a risk factor for the appearance of such fractures, as it reduces the density of the bones (also smoking will contribute to a prolonged healing process, in case of the fracture occurring)

Treatment

The main objective of the treatment is to reposition the broken pieces of the bone, respecting the anatomy of the human body and preventing them from moving, until the healing process is complete. The restoring of the broken bone pieces to their original process is known as reduction, being performed by the orthopedic surgeon. During the immobilization period, the broken bone pieces will become reattached, thanks to the formation of the new bone structures.

If the comminuted fracture is severe and a part of the bone is sticking out, surgical intervention might be necessary. The type of surgical intervention depends on the severity of the fracture but also on the location. The surgeon will choose a different approach in treating the fracture of a vertebra, as opposed to one that has occurred at the level of the leg or the hip.

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Among the most common treatments used for the comminuted fractures, there are:

  • Cast immobilization
    • Plaster or fiberglass cast
    • The doctor will reposition the broken pieces of bone and prevent them from moving by immobilizing the respective limb into a cast
    • The cast will allow for the broken ends of the bone to be kept in an anatomically correct position, until they are healed
  • Functional cast/brace
    • Recommended in less severe fractures
    • Allows for a limited movement in the nearby joints (controlled movement)
  • Traction
    • The pulling action is gentle and steady
    • Purpose – realign the broken bone segments
  • External fixation
    • The broken pieces of the bone are fixed with external elements, such as screws or metal pins
    • The screws or metal pins are attached to a metal bar that is found outside the skin
    • This metal bar acts as a stabilizing frame, allowing for the screws or metal pins to remain in place, until the bone is completely healed
    • In more severe cases, with extensive damage at the level of the soft tissues, external fixators are applied during the surgical intervention
  • Open reduction and internal fixation
    • The first part of the intervention requires for the bones to be re-aligned in the correct anatomical position
    • The surgeon will use internal screws or metal plates in order to keep the broken parts of the bone together
    • Rods might also be inserted into the marrow space, for the same purpose as above
  • Anti-inflammatory medication can be administered with the purpose of pain relief and reduction of inflammation (including in the postoperative period)
  • Antibiotics are administered for prophylactic reasons, so as to reduce the risk of secondary bacterial infections in those who have undergone surgical intervention for the comminuted fracture

Healing time

It is important to keep in mind that a comminuted fracture might take a long time to heal, especially if the damage to the surrounding tissues was severe. On average, it can take between a couple of weeks and several months for such a fracture to heal. The patient will have to stay immobilized for a certain period of time, which also means that the muscles are going to stiffen. Physical therapy is essential to be started, as soon as the cast is off. This can help increase the range of movement in the affected part of the body, reducing the pain and inflammation that occur during the healing process. As the pain is reduced, the physical therapy program concentrates on restoring the normal strength of the muscles, increasing the overall joint flexibility and helping the patient return to the daily activities.

In conclusion, a comminuted fracture is a serious condition and immediate medical intervention is required. The diagnosis of the comminuted fracture is made through clinical examination and medical imaging, if necessary. The treatment consists of the surgical interventions explained above and physical therapy is of invaluable help during the recovery period, promoting a more efficient and faster healing process.

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