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Comminuted fracture, causes, symptoms, treatment – Bone Fracture.

A comminuted fracture is when the bone breaks in more than two pieces. It usually requires a high impact on the bone for achieving that.

In this article, there is going to be a thorough explanation of the most common scenarios of comminuted fractures. However, a necessary description of general fractures would also exist to comprehend this topic better.

By reading this article, you would obtain key insights about comminuted fractures, including its reach, and possible complications. Please, continue reading to get pearls on this topic directly from a doctor.

What is a fracture or broken bone?

A broken bone or bone fracture, according to doctors, is a disruption on the continuous line that shapes the bone. It can look like this (see the image below).

File:Thigh bone fracture - Fracture of femur 6 -- Smart-Servier.png
Complete fracture.
Source: https://commons.wikimedia.org/wiki/File:Thigh_bone_fracture_-Fracture_of_femur_6–_Smart-Servier.png

However, a bone break not only stands for a full separation of the bone. The image above is a complete fracture in which there is an absolute division of the bone generating at least two fracture fragments.

Moreover, there is also an incomplete fracture in which there is a disruption of the bone line but not sufficient enough to generate a division of at least those two fracture fragments.

Therefore, in this scenario, there could be fissures in which there is only affection of the superficial bone surface. Or, there could be fractures that go more in-depth as the greenstick fracture.

File:Kind of fractures - Greenstick -- Smart-Servier.png
Incomplete fracture / Greenstick fracture
Source: https://commons.wikimedia.org/wiki/File:Kind_of_fractures_-Greenstick–_Smart-Servier.png

What are the different types of bone fractures?

Fracture type definition takes into account many variables, such as the mechanism of production, involvement of skin, and according to the fracture pattern. Let us talk about them.

Firstly, according to the mechanism that is producing the fracture, it could be fractured in direct and indirect ways.

Fractures by direct mechanisms comprise the fractures that raise from an impact directly to the bone. On the other hand, in the indirect mechanism, the impact site is somewhere else but in the bone.

The former term is pretty easy to understand; a bone gets hit directly and results broken. However, the last mechanism is not as straightforward. It could have different types, including:

  • Compression fracture.
  • Flexion fracture.
  • Shear fracture.
  • Torsion fracture.
  • Avulsion fracture.

Moreover, there is a classification based on the affection or not of the skin. If in a fracture, the skin remains untouched, it is a closed fracture (also simple fracture). If the skin holes, and there is direct communication between the fracture and the outside world. It is a compound fracture (also open fracture).

The involvement of the soft tissue beneath the skin in a fracture places the ground for more possible complications, like an infection.

Furthermore, complete fractures also have a specific division, which relies on how the fracture looks in a radiograph. This division is essential for medical therapy.

Complete fractures are simple when there is only a line separating the bone, and the fracture fragments remain in alignment. In the image below, the perfect example would the first femur, although it is totally fractured. It remains in its place.

Also, It exists a complete displaced fracture in which the bone fragments lose their alignment. The perfect representation is the middle bone in the image below. Comminuted fracture explanation and classification are ahead.

File:Thigh bone fracture - Fracture of femur -- Smart-Servier.jpg
Source: https://commons.wikimedia.org/wiki/File:Thigh_bone_fracture_-Fracture_of_femur–_Smart-Servier.jpg

What causes a bone fracture?

Three situations can prompt a fracture, and there is another classification just for that purpose. The list includes:

  • Habitual fracture.
  • Pathologic fracture.
  • Stress fracture.

Habitual fracture is when there is a traumatic event that causes injury and overcomes bone resistance when it is healthy. The bones are resistant, but they have a limit. Therefore, when this limit is reached, the bone breaks. Usually, in this type of fracture, it can exist a broad scenario of presentation that will depend specifically on the trauma, such as a car accident, a fall, etc.

A pathological fracture occurs when there is a bone weakness for whatever reason. There are common causes for it as osteoporosis, which is preventable and mostly affects women. In a nutshell, any disease that halts the normal metabolic functions that allow bones to be healthy will end on a pathological fracture.

Besides, there could be malicious processes within the bone as cancers. It could be either bone cancer or from another part in the body that migrated to the bone. So, what happens here? An unhealthy bone is weaker. Hence, it will break with otherwise mild provocation. Most of the time, a pathologic fracture raises doctor’s alarms for looking at what is happening underneath.

A stress fracture is, most of the time, pretty small in the bone. It appears due to repetitive force over a single point, or overuse of a specific activity. For example, high impact exercise, in the long run, like running, could end up in this type of fracture. It can also appear in people with debilitating bone conditions, like osteoporosis.

Furthermore, how fractures are produced can yield particular fracture patterns. For example, shear fracture due to its distinct process produces a transverse fracture. Similarly, torsion fractions cause an oblique fracture.

What is a comminuted fracture?

Now that you have all the necessary tools to understand what is a comminuted fracture. Let us work on that.

A comminuted fracture is a complete fracture in which there are more than two bone fragments. It looks like this (see image below).

File:Kind of fractures - Comminuted -- Smart-Servier.png
Source: https://commons.wikimedia.org/wiki/File:Kind_of_fractures_-Comminuted–_Smart-Servier.png

This fracture includes an extensive list of possibilities. For example, it englobes a three bone fragment of the humerus bone fracture (in the arm) or a multi-part fracture of a given bone cause of a high impact accident. Therefore, the possibilities here are innumerable.

Nevertheless, there is a general idea for a person to get a comminuted fracture. It should be a traumatic event from high strength because it gets to shatter the bone into many pieces. Also, there is the possibility that the bone is weak because of a disease. Hence it could be broken and smashed without a high impact situation.

Is a comminuted fracture considered traumatic?

Generally, a comminuted fracture will be traumatic. This situation is the most common in which a high impact causes the bone to shatter into fragments.

However, it is also a possibility to have a pathological fracture, which only requires an ordinary impact to exist. And, in this scenario, there could also be a comminuted fracture.

Is comminuted fracture considered displaced?

No, a comminuted fracture is when there are more than two fracture fragments. That said, the fact that it is displaced or not depends on the bone’s alignment. If the bone pieces are not in its anatomical (or normal) place, then it is an also displaced fracture.

Therefore, there are comminuted fractures that are displaced and not. To define this situation is essential for both patients and doctors, in light of deciding further treatment and estimating the time of recovery. Of course, all of this depends on numerous factors, such as the site of the fracture, fracture shape, patient’s background, and more.

Can a comminuted fracture be open?

Of course, and this situation is accurate for the profound injuries in high impact accidents. Therefore, it is possible to have a comminuted fracture that is also an open fracture.

How do comminuted fractures happen?

When there is an impact sufficiently hard that surpasses bone resistance, it can break. Also, the specific location of the bearing and its dynamic would influence how the bone breaks. The general idea is that comminuted fractures arise due to accidents involving high energy. However, it is likewise possible to have, for example, a comminuted fracture of the wrist, and not being involved in a precarious accident.

As a case in point, a person who is falling from a standing height that manages to stop it using its hand in extension. That situation could similarly end in a comminuted fracture of the wrist.

Person's Hand in Shallow Photo, fingers, reaching, human hand, HD wallpaper
Hand in extension.

What are some symptoms of a comminuted fracture?

All broken bones manifest nearly the same. The list of signs and symptoms include:

  • The inability to use the part of the body where the fractured bone is. This situation comprises a complete or relative inability to use it depending on it is a displaced fracture, or a fissure, for example, respectively.
  • Pain in the injury and fractured bone area.
  • Swelling of the affected area.
  • It could exist a deformation of the affected area.

It is possible in a severe injury where, besides the bone, the nearby tissues are also affected. This situation includes blood vessels and nerves. It can interrupt the regular blood flow supply to the bone in some cases. Therefore, it can produce avascular necrosis, which is a bone tissue death due to the lack of blood supply. It can lack symptoms or just present as pain in the affected area.

What is a comminuted fracture of the upper extremity?

The upper extremity includes several vital structures, such as the arm, elbow, forearm, wrist, and hand. Together they account for a vast proportion of all the fractures in people; unitedly with the hip and lower extremity fractures. Therefore, they are critical and well-studied worldwide.

Furthermore, let us begin with one of the bones that fractures the most, the radius which is in the forearm (see the image below). The distal radius is the segment of the bone that is closest to the hand, and its fracture is amongst the most common fractures worldwide, mostly due to osteoporosis. Distal radius fracture is often comminuted, so it increases the complexity of the medical resolution.

Also, another essential part of the radius is the radial head, which is the part of the bone that is just below the elbow. Radial head fractures, when comminuted, suppose a challenge for doctors. This situation has surgery as a formal indication, but there are various options.

File:Radius - anterior view2.png
Radius
Source: https://commons.wikimedia.org/wiki/File:Radius_-_anterior_view2.png

The bone in the arm is called humerus (see the image below). This bone can fracture in its proximity to the shoulder, which is a proximal humeral fracture and is relatively common. It can present as a comminuted fracture, which could have either treatment with and without surgery.

In the elbow, there is a vital structure, which is the olecranon (see the image below). This element is part of ulna bone and allows the forearm to perform flexion and extension movements. The olecranon fracture can similarly be comminuted, and it requires surgery.

File:Olecranon labeled.png
Source: https://commons.wikimedia.org/wiki/File:Olecranon_labeled.png

The wrist is formed through eight little bones that connect to the forearm and the hand. The wrist fracture can occur in either of those bones and be comminuted. The treatment here, most of the time, requires surgery.

File:Wrist anatomy.jpg
Wrist
Source: https://commons.wikimedia.org/wiki/File:Wrist_anatomy.jpg

What is a comminuted fracture of the lower extremity?

The lower extremity comprises several essential structures, such as the thigh, the knee, the leg, and the ankle. Let us review some of them.

The femur or thigh bone establishes the connection between the hip and the knee (see the image below). It is a large bone that can be fractured in three places. The fracture could exist in the portion nearer to the hip or the knee and, in the middle. All of those fractures can be comminuted.

The tibia bone is in the leg and also is a popular location for getting fractures that, indeed, can be comminuted. The affection could exist either in the portion of the bone closer to the knee or ankle. Also, it can occur in the middle of the bone.

The knee is a complex articulation. Regarding the bones involved here, you already know two of them, the femur and the tibia. However, there is a third one important one, which is the patella (see image below). The patella fracture accounts for 1% of all the fractures, and when it is comminuted, it is in association with worse outcomes.

What is a comminuted fracture of the spinal column?

The spinal column is essential for the body because it carries the spinal cord, which distributes the nerves to all the body. Therefore, the spinal fracture that causes affection and impairment of the spinal cord will develop nerve problems.

It is possible to have a comminuted fracture in this location that depending on the situation, will require surgery or not. Please remember that every fracture could have its particularities, plus the patient’s background is what will aid in defining medical treatment.

What is a comminuted fracture of the face?

The face has many bones that are explicitly joined for restricting their movement. This complex structure settles the ground for many types of fractures from which it is particularly interesting, the one from the maxilla bone.

The maxilla bone (as you can see in the image) because of its location is susceptible to many fractures, including comminuted fracture. Its management is difficult mainly by intermaxillary fixation using plates and screws or wires. This means that most of the time, it would require surgery for stabilizing the damage.

Can bone fracture heal on its own?

It depends on the fracture, but a fracture may heal on its own with the right measures. Let us discuss some of this exciting topic.

When a fracture occurs, the bone on its own will trigger mechanisms that will lead its healing. It comprises five steps:

  • Impact phase: The swelling will help to attract and activate all the repairing process.
  • Inflammation phase: There is a concentration of all the cells and molecules involved in the healing by a liquid accumulation within the fracture.
  • Soft callus: Early bone growing.
  • Hard callus: There is an ossification of the bone tissue of the previous step.
  • Remodelation phase: The bone restores nearly all its capabilities. This final process could take months or years.

What am I trying to tell you? The bone can heal itself. What the doctor is trying to do is to help the bone to achieve it.

For example, there are simple fractures that do not require surgery. Most of the time, it would be enough by the immobilization of the bone. This measure allows us to isolate the bone in its own healing process. Therefore, it would lead to a healthy progression.

If someone with a fracture does not take the proper measures, it may convert a previously simple fracture, into a complicated one. Fractures must not be overlooked. Also, it is essential to note that following the immobilization, physical therapy is needed for further well-functioning of the body part.

Does a comminuted fracture need surgery?

The accurate answer to this question is depends. Surgical treatment is an indication when the fractures are “unstable” or displaced. And doctors do not find a way to put it back on its place for proper healing without surgery. Therefore, those cases will require surgery.

A surgery will intend to repair the bone and leave it exactly how it was before broken. Doctors have plenty of options for doing so. Each one of these medical resources is useful, depending on the situation and the fracture. None of them will resolve all types of fractures.

Internal fixation is the surgical procedure that binds broken bones by mechanical devices as wires or rods. The list of surgical possibilities includes:

  • Tension band wiring: A technique used for simple transverse fractures.
  • Plate fixation.
  • Bone graft: bone tissue transplantation.
  • Articular prothesis: Joint replacement including the articular surface of the bone.
  • And more.

The fractures that are stable, not displaced, and are simple. They are candidates for not undergoing surgery. Most of the time, doctors would pursue therapy by an immobilization that benefits the patient. However, it is essential to remember that each case must be assessed individually.

How long does it take for a comminuted fracture to heal?

It would depend on the severity of the fracture, and what was the procedure elected. For example, if it was either surgery or immobilization. Also, it depends on the background of the patient. Typically, patients with osteoporosis have longer healing times.

The average time for a fracture to heal is between six to eight weeks. However, as we said, this depends on numerous factors, and a close follow-up by the doctor is always required. Similarly, it is essential to note that fractures continue to heal for months until an acceptable bone is finally achieved.

Do you have broken bones symptoms?

This tool is a fracture symptoms checker. It would help you to assess how likely it is that you are at risk of having a fracture. It is free, and it will take only a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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