A comminuted or fragmental fracture is a violation of the integrity of the bone with the formation of three or more fragments. This is the most difficult type of fracture and is usually accompanied by displacement. The cause of its occurrence is usually the action along the axis of the bone. Injury is also possible with a perpendicular force application.
Diagnosis
The diagnosis of a comminuted fracture is made on the basis of characteristic clinical symptoms (unnatural position of the limb, crepitus, impaired mobility, and so on). In addition, X-ray data must be taken into account.
Treatment
Depending on the nature of the damage, conservative or surgical treatment is possible. Next, we will dwell on the varieties of such a fracture and find out how treatment is carried out in each case.
Fracture of the clavicle with displacement - description of the pathology
Comminuted (comminuted) fractures in this area are commonly seen in adults. ATIn most situations, the integrity of the bone is broken in the middle third, against which the fragments are displaced due to muscle pull. Patients complain of pain, movement is limited, deformity and swelling are determined in the area of damage. Against the background of displacement of fragments, shortening of the shoulder girdle is quite possible. In case of nerve damage, sensory disturbances are detected. When large vessels are injured, massive bleeding is likely. Palpation in such an injury should be very gentle and careful, since pressure on the bone can cause the movement of small fragments and ruptures or compression of intact vessels and nerves.
As part of confirming the diagnosis of a displaced comminuted fracture, an x-ray of the clavicle is prescribed. Therapeutic tactics directly depends on the position of the bone fragment. In the absence of complications, a closed reposition is performed with the imposition of Delbe rings (in case of slight displacement), Weinstein or Sayre bandages. In the presence of damage to the brachial plexus, as well as a fragment that is directed with a sharp end towards the nerves and blood vessels, surgical treatment is indicated in the form of osteosynthesis of the clavicle with a plate, pin or pin.
Fractured humerus
What else could be a shrapnel fracture of the arm?
Such an injury can occur anywhere in that part of the body. The cause is usually a fall on the arm, less often it is a blow or eversion of the upper limb. In case of damage to the upper third (fracture of the head or neck of the shoulder), edema with joint deformity is observed. Movements whilesharply limited. Fracture of the proximal sections, as a rule, proceeds relatively favorably. As a rule, a good result can be achieved using conservative techniques (reposition and subsequent fixation). If it is impossible to compare fragments, osteosynthesis of the head of the shoulder is performed using screws or osteosynthesis with a plate or knitting needles.
When the diaphysis of the shoulder reveals deformity, swelling, crepitus and pathological mobility. Possible compression or violation of the radial nerve or artery. In case of damage to the lower sections (fracture of the intercondylar eminence), the elbow joint is deformed, swollen, and movements are impossible. In the case of a fracture of the diaphysis and the lower part of the shoulder, difficulties often arise during the comparison of fragments.
The tactic of therapy is chosen taking into account complications and X-ray data. If the artery is damaged, emergency surgery is prescribed. In other cases, as a rule, reposition is performed or skeletal traction is applied. When fragments cannot be compared, osteosynthesis of the bone diaphysis is carried out with a plate or knitting needles. Surgical intervention to restore the nerves is usually performed in the long term. In the absence of tension, a nerve suture is shown; otherwise, plastic surgery of the damaged trunk is used.
Forearm bone fractures
Such injuries can be extra-articular and are located in the middle, lower or upper third of the segment. Among the intra-articular include a fragmental fracture of the olecranon and the head of the beam in combination with a dislocation of the bone of the forearm. For all of the above types of damageedema and deformity of the joints are observed. At the same time, movements are sharply limited or impossible at all. The tactics of therapy are determined taking into account the radiography of the ulnar element. Surgery is often required in the form of osteosynthesis of the olecranon with wires or screws, and, in addition, resection of the radial head.
Shaft fracture of the hand is a fairly common injury. It is accompanied by visible deformity, mobility, edema, pathology of the axis of the limb. Holding the fragment after reposition with this injury often becomes a very difficult task even in the case of a simple transverse or oblique fracture, since the fragments are re-displaced due to muscle traction. In the case of fragments, the task becomes more complicated, therefore, it is often necessary to turn to surgical treatment. The tactics of surgical intervention is determined taking into account the radiography of the forearm. Osteosynthesis is quite possible.
Comminuted fracture of the beam in a typical area is also not uncommon. Usually observed displacement of fragments. The wrist joints are deformed, edematous, and movements are sharply hampered. Crepitus is uncharacteristic. X-ray reveals a fracture with a variable number of fragments. In most cases, the displacement is eliminated during closed reposition; in some situations, osteosynthesis of the ray metaepiphysis with pins or a plate is necessary.
Pelvic Fracture
Comminuted fractures of the pelvis are formed during intense traumatic action (road injuries, fallsfrom a considerable height), often go in combination with a discontinuity of the ring and act as severe damage, which is accompanied by the development of traumatic shock. Damage to the anterior and posterior half-ring, the lateral mass of the sacrum and the acetabulum is not excluded. Doctors reveal at the same time a pronounced pain syndrome. The movements are very limited, among other things, reliance on the legs is impossible, a forced position of the limbs is observed, which depends on the type of fracture. The diagnosis is made on the basis of a pelvic radiograph. When displaced, skeletal traction is performed.
Comminuted hip fracture
This injury occurs in the lower third, less often in the area of the trochanter. A comminuted cervical fracture is very rare. The injury is usually accompanied by pain, swelling, deformity, and painful mobility. Support is not possible. With intra-articular damage, hemarthrosis is determined. Diagnosis is confirmed by X-ray of the thigh.
Therapy
The treatment of fractures in this case is more often conservative, with the use of skeletal traction. In case of unstable damage, osteosynthesis is performed with curved plates or spongy screws. Treatment of diaphyseal fractures can be conservative (skeletal traction) or surgical. Surgical intervention is prescribed for patients when it is impossible to properly match the fragments due to soft tissue interposition.
Comminuted fracture of the lower leg
Shrapnel fracture of the leg in the shin area is a common injury,which is formed as a result of a jump from a certain height or a blow to the shin. It is often the result of road accidents (bumper fractures). Injuries in the lower sections often occur when a limb is twisted. Against the background of intra-articular fractures of the upper third, pain is noted along with hemarthrosis, significant swelling and deformity of the knee joint. Crepitus may be completely absent. Such fractures are accompanied by severe pain, deformity, failure of the axis of the limb, and pathological mobility. Deformity may occur in combination with severe swelling of the ankle joint.
Treatment of shrapnel fractures of the lower leg is more often performed surgically. Doctors perform osteosynthesis of the tibia with screws. With a diaphyseal fracture, it is possible to use skeletal traction for four weeks, in the subsequent follow-up process takes place in a plaster cast. However, due to the difficulty of comparing a significant number of fragments and the need to prevent contractures today, with such injuries, surgical techniques are increasingly used in the form of osteosynthesis of the tibia bones with screws or pins.
Ankle fracture
When ankle fractures, doctors tend to stick to conservative tactics. In the event that the fragments cannot be compared during closed reposition, osteosynthesis with a plate or tension loop is resorted to. Sometimes transarticular fixation with wires is performed.
Fractured spine
Is there a fragment fracture of the spine?Let's figure it out.
This injury is very rare (only twelve percent of cases) and is one of the most severe fractures. The pathology got its name due to the fact that bone fragments break off from the vertebrae, which can injure the spinal cord, nerves or blood vessels. A variation of this fracture is the explosive type. It is characterized by the presence of two or more fragments (more often it is five or more).
As part of therapy, conservative treatment is carried out. The patient is prescribed painkillers in the form of "Ketanov" or "Ketalong". A special corset or bandage is put on the damaged area of the spine for up to six months.
Toe and heel fractures - detailed description
With a fragmental fracture of the heel, as in previous cases, fragments are formed. Treatment is required conservative. But besides this, with such injuries, as a rule, skeletal traction is applied for the injured finger. To eliminate heel injury, surgical intervention is performed in the form of open reposition and osteosynthesis with a pin. Comminuted finger fracture heals faster.
Complication
In patients with such fractures, especially with multiple and combined trauma, with open injuries of the pelvic bones or thighs, fat embolism may occur along with traumatic toxicosis, anemia. Fractures in elderly patients are very often complicated by pneumonia, and in those who suffer from alcoholism, acutepsychosis.
With open fractures (especially with extensive tissue damage), suppuration of the wound is possible in combination with osteomyelitis. Late complications include delayed bone fusion and the formation of a false joint. In addition, improper fusion is possible along with contracture, post-traumatic arthrosis, edema, and more.
Thus, when receiving this kind of injury, regardless of the area of its location, it is necessary to take the treatment seriously and follow all the doctor's recommendations, since otherwise adverse complications are possible.
