Comminutive fracture
A fracture is defined as a discontinuity of the bone, caused by a trauma, which acts on a bone
weakened by a previous suffering (osteoporosis, bone tumor, osteitis, etc.), in the case of trauma
caused by low energy, or a trauma of high intensity that can cause fractures on a healthy bone in
young people or adults.
So we can talk about fractures of healthy bones and fractures of diseased bones, improperly
called pathological fractures.
The fracture is not only a simple traumatic accident with local repercussions, but a complex
pathology process that involves the whole body. A fracture is a generalized disease with general
post-traumatic disorders. Fractures can be classified as follows:
Depending on how the determining force acts:
1. Direct fracture occurs at the level at which the force acts, represented by crushing,
compression or violent shock. These are fractures that occur in major accidents, which are
associated with more or less serious injuries to the soft parts.
2. Indirect fracture occurs elsewhere than where the traumatic agent acted. These fractures are
the most numerous and depending on the application of the trauma, different anatomo-
pathological types of fractures can occur. In indirect fractures, traumas can act through one of the
following 4 mechani[Link]
• a. Flexion, when the force is exerted on a bone curvature that, exceeding the normal elasticity,
breaks the bone at maximum curvature;
• b. Traction, following violent muscle contractions that lead to the tearing of bone fragments,
which have tendon insertion areas or parcel fractures of the epiphyses by ligament traction;
• c. Compression, along the bone axis, leading to the fracture of the epiphysis, as in the fractures
of the talus or tibial pilon following the fall from height;
• d. Torsion, when the vulnerable force produces a twist of the limb always causing a spinoid or
helical fracture.
[Link] on the degree of bone discontinuity
1. Incomplete fractures, which are observed mainly in children and come in the following forms:
• a. Deformation of the bone in thickness, which takes place through a pressure mechanism along
the bone. Under these conditions, a trabecular dislocation occurs more in the metadiaphyseal
region, which translates radiographically by a slight fusiform or ring thickening;
• b. Incomplete or flexion rupture, which is observed in children when due to the elasticity and
thickness of the periosteum there is a fracture path that affects only the cortex from the convexity
of the bone. The fracture “en bois vert” (in green wood) is classic;
• c. Depressed fracture, is observed especially in the wide bones of the skull;
• d. Cracks, are found especially in adults and less often in children, the formal integrity of the
bone is preserved and only radiographs from different incidences can show the fracture
trajectory.
2. Complete fractures can have the fracture trajectory with variable location, in case of direct
fracture and on the contrary, to be located at the level of the weak points of the bone if the
fracture is indirect. The path can be transverse, oblique, spiroid, longitudinal, clarinet tip and
butterfly flour.
The fragments are generally two in number, sometimes an accessory fracture path separates a
third fragment. When there are several trajectories, the fracture is cominutive, the bone
fragments being called scales. The movement of the fragments is variable, sometimes
minor, sometimes complex. This trip can be done:
• a. By translation, when one of the fragments is moved forward, backward, internally or
externally, relative to the other fragments, producing their overlap;
• b. By rotation, when one fragment rotates around its longitudinal axis, while the other remains
immobile or both fragments rotate relative to each other, in these cases there is a gap of the
fragments;
• c. By angling one fragment to the other. Usually, the fragments undergo complex
displacements, when the angulation is associated with the riding or the lateral displacement with
lag.
• Depending on the integrity of the skin, fractures can be:
• 1. Closed fractures, when bone segments are covered at least by the skin.
2. Open fractures, in which the skin has been damaged and the bone comes into contact with the
outside. In this case it can become infected, a septic process of osteitis or even osteomyelitis can
occur which delays healing or can give rise to complications, bone damage, vicious callus,
pseudoarthrosis.
These types of fractures are classified according to the appearance of the skin, as follows:
- Open fractures (skin has a wound and bones can be seen)
- Closed fractures (skin has no wound, bones are not visible)
This type of fracture is classified by the number of bone fractures in: - Simple fractures (breaking
the bone in one place) - Cominutive fractures (breaking of the bone in several places) • The most
common cases of fractures are those of the limbs, and the most affected age category is that of
people over 50-60 years.
Causes
• In healthy people, the fracture usually has as its main cause a blow / violent trauma resulting
from a fall or blows and can be accompanied by serious injuries such as dislocation or
neurovascular injuries.
In patients with various diseases, the fracture occurs due to qualitative deterioration of the bones.
For example, osteoporosis can occur in women who have reached the menopausal stage, which is
a factor that favours the appearance of fractures.
Children are the least affected, because in the early period of life the bones are elastic and
healthy.
Possible causes of fracture are:
• severe trauma, severe blow
• osteoporosis
• chronic bone infection
• bone cyst
• stress fracture
• other congenital diseases that affect the bones
• Symptoms
• The first symptoms of a fracture are severe pain. These can diminish after a relatively short
time, but they will not disappear.
• immediate, strong pain
• the pain gradually subsides after a few hours, but does not go away
• inability to move the affected area normally
• deformation of the affected region
• bruising that occurs 24-48 hours after the event
• Diagnosis
• Orthopedic examination is mandatory to confirm a diagnosis of fracture and to follow
appropriate treatment.
In most cases, the diagnosis of fracture is justified by abnormal mobility, accompanied by noise
and an unusual sensation at palpation.
To establish the diagnosis, the doctor will ask for an x-ray. In more special cases, the orthopedist
may require analysis by tomography or nuclear magnetic resonance.
Fracture: diagnosis
The diagnosis is made on radiographic examinations in various incidences or, in particular
cases in which the radiography does not support a definite diagnosis, a CT tomography
examination is indicated.