In this article, we will introduce in detail about comminuted fracture definition, causes, most common symptoms, treatment, recovery period, complication and prevention in daily life.
Comminuted fracture Overview
|Common areas of occurrence||Four limbs, long bone, vertebrae|
|Common Causes||Direct violence, indirect violence|
|Prone Population||Elderly person|
|Common symptoms||Pain, swelling, limited activity|
|Department||Orthopedic, Pediatric, Emergency|
A comminuted fracture belongs to the group of complete fracture. This means that the bone is broken into more than three pieces, so it is also called a T or Y type fracture. Comminuted fracture generally refers to the destruction of bone integrity or continuity due to direct or indirect violence or long-term strain. Patients may have clinical manifestations such as local pain, swelling, and movement disorders. Because there are many fragments of bones, the effect of fracture reduction is not ideal, and the stability is also poor, so most of them need surgery. Improper treatment of such fractures may have sequelae.
It is the main cause of most comminuted fractures. Bone fracture occurs in external violence such as injuries, bruises, gunshot, blast injuries and impact injuries. Most of these fractures are characterized by transverse fractures or comminuted fractures. Soft tissue damage at the fracture site is more serious.
It includes communicating violence and reversing forces. This does not occur in areas that are directly hit by external forces, but in other parts.
Muscle pull fracture
This refers to fracture due to sudden contraction and stretching of the muscle. Such as humeral fracture, humeral shaft fracture, the fifth humeral base fracture is a comminuted fracture caused by muscle traction.
These fractures are mostly caused by excessive bone fatigue. Fatigue fractures are prone to occur after long journeys, and the fractures of the third metatarsal bones and the lower third of the humeral shaft are more common. This type of fracture has no displacement, but it has a slow recovery period.
- Pain and swelling: Pain and swelling are the most common fracture symptoms. Pain can even make people feel sick and vomiting. There will be swelling and tenderness around the fracture.
- Deformation: Displacement of the comminuted fracture segment can change the shape of the affected limb. There is also significant swelling in the affected area.
- Abnormal movement: Abnormal movement occurs in the injured area after a comminuted fracture.
- Bone crepitus: Bone crepitus may be heard when the two fracture ends rub against each other after a comminuted fracture.
- Fever: If there is a large amount of internal bleeding at the fracture, the body temperature rises slightly when the hematoma is absorbed. This is one of the common symptoms of comminuted fractures.
- Shock: Patients with severely comminuted fractures often cause shock due to massive blood loss, soft tissue damage, severe pain, and the like.
Why are older people prone to comminuted fractures?
Comminuted fractures usually occur in the elderly, which is related to calcium deficiency in the elderly. The elderly suffer from more bone loss due to endocrine changes, decreased body function, long-term unreasonable calcium deficiency diet, and less outdoor activities. This will result in loose bone structure and weak bones. In this case, comminuted fractures are easily caused by external force damage.
X-ray plain films (including anterior, lateral) can clear the diagnosis, and those complicated cases also can be diagnosed with CT scan or MRI. CT scan plays a major role in the diagnosis and prognosis of the fracture classification. CT examinations should be performed for complex pelvic fractures or suspected intraspinal fractures.
Diagnosis can be confirmed based on medical history, symptoms, and imaging.
1) Surgical treatment
The comminuted fracture treatment has a surgical fixation and long bone interlocking intramedullary nail fixation. Non-displaced fractures can be treated with external plastering and symptomatic treatment. Displaced fractures can be surgically repositioned and fixed by wire. Surgical patients need antibiotics to prevent postoperative infection. If the wound is not infected for 48 hours after surgery, the antibiotics can be discontinued.
2) Medical treatment(non-surgical treatment)
Comminuted fractures with surgical contraindications such as poor general condition, or severe liver and kidney disease, can choose non-surgical treatment. Fixation can be performed with plaster or splint depending on the degree of comminution and the degree of reduction. The affected area is usually fixed for 4 to 6 weeks, and the external fixation can be replaced according to the specific conditions. After removing the plaster, perform functional exercise under doctor advice.
Usually, it takes at least 3 months to half a year for the limb fracture to heal. This has a certain relationship with the blood supply to the fracture site, the degree of soft tissue damage, the recovery of the body and the method of treatment. Older people may take longer to recover.
Ideal healing: The fracture is well positioned, the function is fully or substantially restored, and the surgical wound heals.
Bad healing: Fracture alignment is not ideal, limb function is significantly limited.
Early effective functional exercise is to raise the affected limb or place a pillow under the affected limb. If the affected limb is higher than the heart level, the blood circulation can be accelerated, which is conducive to the formation of the epiphysis.
The patient can exercise on various joints and toes of the affected limb in bed. This can promote the blood circulation of the affected limb, reduce muscle atrophy and adhesion, maintain muscle strength, prevent joint stiffness and promote fracture healing.
Patients need to actively perform some functional exercises on unfixed joints.
When the fractured end has reached clinical healing, some weight-bearing exercises can be gradually added.
- Blood vessels and nerve damage: If there are large blood vessels and nerves along the bone, damage may occur. For example, a supracondylar fracture of the humerus can damage the radial artery, and a fracture of the clavicle can damage the subclavian artery.
- Fat embolism: The tension of the hematoma at the fractured end causes the fat particles to enter the vein of the body from the marrow cavity, causing lung embolism and brain embolism. It is characterized by difficulty breathing, cyanosis or coma, and even sudden death.
- Joint stiffness: Long-term fixation, inadequate functional exercise, muscle contracture can cause joint stiffness.
- Decubitus (bedsore): Patients with severe fractures who have been bedridden for a long time are prone to bedsore. This is because some parts of the body are often oppressed, resulting in poor local blood circulation. So patients often need to be turned over, massaged and wiped by family or nurse. The bed should also be flat, dry and clean.
- Pneumonia and urinary tract infections: Pneumonia and urinary tract infections mainly occur in patients who need to be bedridden for a long time after a fracture. Especially elderly, frail and patients with chronic diseases are more common. In severe cases, the patient’s life can also be endangered. If the patient has symptoms such as respiratory distress, cough, low fever, abdominal pain, urinary soreness, they need to seek medical advice in time to avoid the infection getting worse.
- Infection and sepsis: Open wounds or surgical treatment can cause wound infection, soft tissue infection, osteomyelitis and even systemic infection.
- Complications related to fracture healing: In addition to the above complications, delayed fracture healing, nonunion, fracture malunion, and re-fracture may occur. Internal fixation failure is also one of the complications.
Pay attention to safety in daily life to prevent trauma and accidents.
The elderly can do some functional sports activities every day to improve the bone quality. The elderly also need to add some calcium-rich foods to their diets and do regular medical examinations to prevent osteoporosis.
What should I pay attention to when I have just finished a comminuted fracture surgery?
In order to promote the venous return of the affected limb and improve blood circulation, the affected limb needs to be raised above the heart level. Patients can use a pillow or raise the tail of the bed.
Patients can eat after 6 hours of surgery. You need to choose digestible foods such as greens, fruits, rice porridge. Patients should not take indigestible foods like eggs, soy products, milk to prevent bloating. Patients also need to drink more water, not less than 1500 ml per day. Hot, sour, cold, fried foods also need to be avoided. The patient can eat high-protein, high-vitamin, high-calorie diet on the second day after surgery to improve the patient’s nutritional status and enhance the body’s immunity.
Vitamin A, vitamin D, calcium, and protein can be added after 5 days. Patients can gradually take calcium-rich milk, soy products, and shrimp skin. At the same time, patients need to add vitamin D to help with calcium absorption.
- Bone fracture overview, causes, symptoms, types, diagnosis, treatment, and prevention.
- Types of fractures in the human body
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- Written by Nurmemet, MD (Emergency Medicine Specialist)
- Medically reviewed by Merhaba, MD (Pediatrician)