Update : 16 March 2024 1.48 AM IST
What is Comminuted Fracture ?
The Fractured bone is broken into more than two pieces is known as Comminuted fracture.Its occurs due to a direct Injury.
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| Femur comminuted fracture |
•Femur
•Tibia
•Fibula
•Humerus
•Radius and ulna
•Clavicle
•Skull.
Causes:
Comminuted fractures are caused by trauma like Motor vehicle Accident , fall form height, direct hard external objects trauma etc.
Risk factors:
• Highly alcohol consumption : reduce bone density.
• Osteoporosis personal : easily broke bone.
• Calcium Deficiency.
• vitamin D Deficiency.
symptoms:
•Bruising
•Seeing your bone through your skin.
•Not being able to move a part of your body
•Pain
•Swelling
•out of its usual place.
Types of comminuted fracture
•Simple or Closed comminuted fracture
•Compound or Open comminuted fracture
The Different Between Simple or Close comminuted fracture vs Compound or Open comminuted fracture:
Simple or Closed
In this type, the fracture does not communicate with the exterior as there is no wound directly over the fracture.
Compound or Open
In this type, the fracture communicates with the exterior through a wound over the fracture. The management of compound fracture may pose problems of skin and soft tissue loss and subsequent infection, etc.
Investigation of comminuted fracture
X-rays: An X-ray will confirm any comminuted fracture.
Magnetic Resonance Imaging (MRI): to get a complete picture of the damage to your bones and the area around them. This will show them tissue around your bones too. This is especially important to determine how your muscles, connective tissue and organs were affected by the trauma.
CT scan: A CT scan willl more detailed picture of your bones and the surrounding tissue than an X-ray.
Treatment:
Surgery:
• Internal Fixation :
Internal fixation done by various type of implants such as screws,plates and Nails. Internal fixation is performed along with cancellous bone grafting in case of delayed union or nonunion.
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| Internal fixation |
•External Fixation
External fixation is an excellent method of treating an open or compound fracture with severe soft tissue damage. It stabilizes the fractured bone; it allows easy wound care, and permits surgi- cal procedures like skin grafts and bone grafting. The external fixator can be a tubular fixator where Schanz pins are passed into the bone and connected to a tubular rod , or a ring fixator where wires are passed into the bone under tension and connected to a half or full circle ring . However, the external fixator occasionally poses the problems of pin tract infection and loosening of pins.
| Medicine: |
NSAID,Calcium, Vitamin D , Antibiotics ,etc
Mobilization and Rehabilitation:
It is the final stage of fracture treatment. The objective is to restore near-normal mobility to the fractured limb and make the patient physically independent. It is in fact the total responsibil- ity of the physiotherapist.
Role of Physiotherapy
Role and Responsibility: The role of physiotherapy in fracture management is so valuable that none can boast of a 100% recov- ery without the attention and care by a physiotherapist.
Healing of Comminuted fracture
The healing of fractured bone occurs in three phases :
1. Inflammatory phase
2. Cellular proliferation phase
3. Remodelling phase
Inflammatory Phase
Haematoma (a clot) is formed between and around the broken bone ends. It follows vasodilation, release of protein and blood cells in this area. Histocytes, mast cells and polymorphonuclear leucocytes invade the toxic bacteria and clear the debris. New granulation tissue is formed due to cell proliferation between the bone ends.
Cellular Proliferation Phase
The granulation tissue thus formed between the bone ends bridges the gap between the fractured bone ends. The bone ends become rarified and calcium is laid down in the granulation tissue as callus. Similar activity goes on in the medullary cavity also. The external and the medullary callus may meet and unite the fracture. At this stage, the fracture is said to be united clinically, but it is not strong enough to be exposed to stress.
Remodelling Phase
This is the phase of remodelling of the callus towards normal ossification. The soft callus gets consolidated by the deposition of bone salts. This is carried out by osteoblasts. The multinucleate osteoclasts then come into action and properly control the density of the new bone. The medullary cavity is reproduced and the marrow cells reappear. The process of remodelling ends by reconstruction of new bone similar to the one before injury.
The bone tissue always heals by forming new bone which has all the characteristics of a normal bone. Healing never occurs by scar formation like other body tissues.
Read: Fundamental Stages of the Treatment of Fractures