Comminuted Fracture

What is a comminuted fracture?

Also labeled as multifragmentary fracture, a comminuted bone fracture is a medical situation describing an injury somewhere along the length of the bone that arises as soon as a rapid blow or an overwhelming force is directed towards the bone, leading it to splinter into three or more portions. For minor bone structures to suffer breaks and fractures, it is estimated to receive 9 to 13 pounds of pressure. Bigger bones, the femur for instance, have breaking peaks as great as 160 lbs of pressure. The fracture is classified as being open or closed. In a closed fracture, the skin is still intact, as opposed to open fractures where the skin is damaged and bones are projected on the outside.

Any bone which takes an impact with enough pounds of pressure can break .The forearm and the wrist are the most frequent anatomical parts subjected to a comminuted form of fracture. The exact mechanism involved in most of these situations is the person’s defense reaction to take falls with hands. Thus, radius, which provides the most foundation, receives most of the force, thus, has the potential to break up.

Common recipients of this kind of bone fracture are the bicyclists. As a result of the momentum at their back, they frequently trip over from an upper point with much more impact. Several other sports and actions that need physical contact or utilize solid surfaces raises an individual’s vulnerability to fractures. Another usual group is the aged, especially those who have bone diseases like osteosarcoma, osteogenesis imperfecta, osteoporosis and hormonal disproportions which restricts bone growth, development and repair. Fortunately, a lot of these bone conditions can be prevented by a high-calcium, high-protein diet.

Making a diagnosis is simple. At first, the physician obtains a physical assessment and a patient’s medical history. An x-ray is needed to visualize the suspected fracture. Once it has been x-rayed, the physician can make use of the image to collect further details of the orientation of the fragmented bone to establish the most fitting treatment approach possible. In some situations, a computed tomography maybe required.

If left untreated, complications may appear that affect the bone’s healing process. This may include infection, compartment syndrome and vascular necrosis. Several follow-up health checks can be scheduled by the physician to periodically assess if fracture has been situated as it should be, and if healing process is fast or too gradual. If the doctor discovers that healing isn’t progressing as wanted, then interventions can be rendered to deal with this problem.

Symptoms

Similar to several other fractures, a comminuted one is associated with characteristic manifestations prompting subjects to seek out medical and surgical care.

• Commonly, they report tremendous pain at the fractured area which begins the moment one sustains the damage. Even if bone tissues do not have nociceptors, still, fracture presents an unbearable sensation. This might be due to a number of explanations. First, any split in the continuity of the periosteum, the sheath that surrounds the bones, with or without the involvement of the vascular tissue lining of the bones produces excruciating feeling as these structures contain multiple pain receptors. Secondly, the adjacent soft tissues become edematous due to hemorrhage of worn out periosteum vessels; in consequence, pressure pain is induced. Lastly, in an attempt to maintain the bone segments in place, muscles become spastic.
• They may even lose their consciousness once the splintering happens as derived from pain.
• Signs of inflammation can be observed in the injured area, such as swelling, skin discoloration and warmth.
• Naturally, the person can’t tolerate carrying an object on the fracture without being subjected to considerable pain.

Causes

Bones are durable in nature and do not easily yield to insignificant pressure. For a bone structure to become splintered to pieces, a tremendous blow is necessary. Such situations where bones are unable to withstand pressure may include the following;

• Vehicular accidents
• Severe fall from a height
• Gun shots
• Advancing age
• Bone diseases

Additionally, those who are chronic smokers are likely to have reduced bone density, thus, they are at higher risk of getting fractures. Another issue on smoking is its effect on the healing process. It has been found out that smoking suspends bone healing, causing healing time to double in comparison to non-smokers.

Treatment

Treating comminuted fractures can be very difficult because of the involvedness of too many fragmented pieces. This can also become particularly challenging when the bone fracture is open as infection and slow healing process are typically the issues to consider throughout the treatment.

Normally, when the body sustains breaks in the bone, a natural mechanism begins in order to repair the damage. Hence, the goal of treatment is directed in re-establishing the normal placement of the fragmented bones in order that it may still perform the usual functions following its complete healing.

• For this principle, the shattered pieces are lined up in a procedure labeled as reduction. Immobilization above and below the injured area is maintained with the aid of fiberglass cast, plasters and splints.
• For lesser bones that have been injured like the phalanges of toes and fingers, seldom, immobilization is achieved by buddy wrapping. With this, only a limited movement is allowed, therefore, the anatomical position is sustained while permitting callus formation.
• For pain management, especially in arm fractures, the use of ibuprofen provides relief that is similarly effective to the combined acetaminophen and codeine.
• In impacted fractures where the fragmented ends are forcefully jammed together by massive force, an invasive method termed as open reduction which makes use of surgical nails, screws, plates and wires, is necessary with the intention of preserving the original position of the splintered pieces.
• When the above approaches fall short in giving reasonable results, then more invasive forms of management are applied. In compression type of fracture for instance, conservative approach consistently fails as vertebrae are already involved. A better approach involves vertebroplasty, a surgical method where cement is injected into the broken vertebrae to offer stability to the spinal column.
• If bone infection arises, meticulous antiseptic measures and prophylactic antibiotics are mandatory. Infection is a major concern as this is particularly harmful in bones, because of the recrudescent quality of bone infections.

More often than not, treatment is maintained for an extended duration because fractured bones take a great deal of time to restore its normal condition. Regular appointment with a doctor is recommended to guarantee the good condition of the bones. Since healing process may take for more than a few months, physical therapy may be needed for the patient to rapidly pull through.