What is a Comminuted Fracture?
To answer the question of what a comminuted fracture is, one must start with this question: what is a fracture? The term “broken bone” is another to consider. Bones fracture when they are under too much stress. A high force impact also causes a fracture. Several medical conditions also cause broken bones, including osteoporosis, brittle bone diseases, and some forms of cancer. These conditions weaken the bones, leaving them more susceptible to breaking.1 A comminuted fracture is a specific situation where the bone has splintered into more than two fragments. “Fracture” is an umbrella term for a variety of specific types of broken bones. Comminuted fractures usually occur after vehicular accidents and similar high-impact trauma events. Standard treatments are generally inadequate for fixing comminuted fractures. They require more specialized treatment than a standard fracture. Fractures are very serious injuries. Medical treatment is always necessary.2
Different Types of Fractures
There are other, more specific, terms for fractures beyond “comminuted”. Muscles or ligaments can pull on the bone, causing an avulsion fracture. Fracture dislocation is when one of the bones in a dislocated shoulder is broken. Hairline fractures are partial and are harder to spot by routine x-rays. The softer and more elastic bones of children more commonly experience greenstick fractures. Underlying conditions cause pathological fractures. When the bone has been twisted, it is a spiral fracture. A buckle fracture, or torus fracture, is a bone that has become deformed but not cracked. It is another fracture that is more common in children. When one fragment of bone enters another bone, it is as an impacted fracture. Compression fractures affect the spongy bone in the spine.3
Fracture vs Break
“Fracture” and “break” are interchangeable terms. In both cases, they mean that a bone has been shattered in some way. A partially broken bone might be a hairline fracture. Bones can also be entirely broken into two or more parts. Doctors are likely to use the term “fracture” on something which many people will call a “broken bone”. This is a linguistic difference which is not affected by the type of injury itself. Other than the words themselves, there is no official difference between a fracture and a break in relation to bones. No matter what it is called, patients need to seek medical attention immediately. Not all fractures are life-threatening, but they should never be left untreated. The break could affect something internally, unnoticed by the patient, that a doctor will be able to catch. The name is not the important part. Treatment needs to begin immediately.4
Symptoms of Fractures
Symptoms vary based on which bone was broken, how it fractured, and the age and health of the patient. Generally, these are some of the symptoms: pain, swelling, discolored skin in the affected area, lack of mobility, bleeding, and a grating sensation in the fractured area. Larger bone fractures yield symptoms like dizziness, nausea, and a pale and clammy complexion on the patient. When it has become evident that a bone could be broken, the patient should not be moved until a medical professional has arrived. An exception to this is when the patient is in an environment which poses a threat, such as a busy road. Otherwise, moving the patient can cause further damage. The doctor will examine the patient, likely with the help of an X-ray, in order to determine exactly where and how severe the fracture is. This will determine the treatment method used.5
How Are Fractures Treated?
Bones will heal themselves naturally in most cases. It takes time for the body to mend itself, and doctors still have to intervene. The doctor sets the bone. When the bone is set, it will heal in the proper position and function normally again. The bone and surrounding area need to be immobilized, and plaster casts, metal plates and screws, internal rods, and external fixators are used to keep the bone in place. In a standard case, the bone will stay immobilized for two to eight weeks. The duration is dependent on the onset of complications, such as infection or other external and internal factors. Patients need to be compliant in order to let the bone heal properly and fully. Patients who smoke will find that the healing process takes longer. Physical therapy starts after the bone has healed to help the patient regain muscle strength and mobility.6
Treating Comminuted Fractures
Comminuted fractures very often require more invasive treatment. Splints, casts, and other external fixation devices are usually inadequate in this situation. The complications are because of the multiple breaks in the bone and the serious trauma event which usually causes them. Open surgery is necessary so that the bones can be restructured to fit the anatomy normally. The additional breaks could add to recovery time. Surgery is necessary to repair the area of the body that surrounds the fracture. The multiple breaks can even cause damage which pierces the skin.7 Patients in recovery need to be very cautious and they should immediately report any abnormality to a medical professional. Even properly healed broken bones can leave the patients with lasting effects. The area might become permanently stiff.
Ways to Prevent Future Fractures
Going forward, there are ways for patients to prevent fractures from occurring in the future. Major accidents or unexpected injuries cannot always be avoided. Patients still have to keep their bones strong. Calcium and weight-bearing exercises help maintain bone strength. It is natural to lose bone mass in later years, so the intake of daily calcium and vitamin D should be increased. Weight-bearing exercises do not have to be daunting. Even going for a walk contributes to bone health. Additionally, there are environmental changes that can be made. Patients should make sure that there is nothing to trip over in their own homes, such as wires or general clutter. Nightlights and no-slip pads combat unexpected falls. Yoga and tai chi improve balance and strength. The patient’s whole body will benefit from physical therapy. Future fractures are prevented with effort.8
References:
1, 3, 5, 6 https://www.medicalnewstoday.com/articles/173312.php
2, 7 https://www.spine-health.com/glossary/comminuted-fracture
4, 8 https://www.healthline.com/health/fracture-vs-break#treatment
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