A comminuted or fragmented fracture is a violation of the integrity of the bone with the formation of three or more fragments. This is the most complex type of fracture, which is usually accompanied by displacement. The reason for its occurrence is usually the action along the axis of the bone. It is also possible injury with a perpendicular force application.
Diagnostics
A fragmentation fracture is diagnosed on the basis of characteristic clinical symptoms (unnatural limb position, crepitus, impaired mobility, and so on). In addition, radiography data is necessarily taken into account.
Treatment
Depending on the nature of the damage, conservative or surgical treatment is possible. Next, we dwell on the varieties of such a fracture and find out how treatment is carried out in each case.
Clavicle fracture with displacement - a description of the pathology
Cellular (fragmentation) fractures of this area are usually found among adults. In most situations, the integrity of the bone is violated in the middle third, against the background of this fragments are displaced due to muscle traction. Patients complain of pain, movement is limited, deformation and edema are determined in the area of damage. Against the background of displacement of fragments, it is quite possible to shorten the shoulder girdle. In case of nerve damage, sensitivity disorders are detected. When large vessels are injured, massive bleeding is likely. Palpation with such an injury should be very careful 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 the confirmation of the diagnosis of a fragmented fracture with a shift, radiography of the clavicle is prescribed. Therapeutic tactics directly depend on the position of the bone fragment. In the absence of complications, a closed reposition is performed with the superposition 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 clavicle osteosynthesis with a plate, spoke or pin.
Humerus fracture
What else could be a fragmented arm fracture?
Such trauma can occur in any part of this part of the body. The reason usually is a fall on the arm, less often it is a blow or twisting of the upper limb. In case of damage to the upper third (fracture of the head or neck of the shoulder), edema with joint deformation is observed. The movements are sharply 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 not possible to compare fragments, osteosynthesis of the shoulder head is performed using screws or osteosynthesis with a plate or knitting needles.
When the diaphysis of the shoulder reveals deformation, edema, crepitus and pathological mobility. It is possible squeezing or violation of the radial nerve or artery. In case of damage to the lower sections (fracture of the intercondylar elevation), the elbow joint is deformed, swollen, and movement is 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 tactics of therapy are selected, taking into account the complications and radiography data. If the artery is damaged, an emergency operation is prescribed. In other cases, as a rule, reposition is performed or skeletal traction is applied. When the fragments cannot be compared, osteosynthesis of the diaphysis of the bone is carried out with a plate or spokes. Surgery to restore nerves is usually done in the long term. In the absence of tension, the nerve suture is shown; otherwise, plastic of the damaged trunk is used.
Forearm fractures
Such injuries can be extra-articular and are located in the middle, lower or upper third of the segment. Among the intraarticular include fragmentation fracture of the ulnar process and the head of the beam in combination with a dislocation of the forearm bone. With all of the above types of damage, swelling and deformation of the joints are observed. The movements are sharply limited or impossible at all. The tactics of therapy are determined taking into account the radiography of the elbow element. Often surgery is required in the form of osteosynthesis of the ulnar process with knitting needles or screws, and, in addition, a resection of the head of the radius bone.
Diaphyseal fragmentation of a hand fracture is a fairly common injury. It is accompanied by visible deformation, mobility, edema, pathology of the axis of the limb. Holding the fragment after reposition during a given injury often becomes a very difficult task even in the case of a simple transverse or oblique fracture, since the fragments are displaced repeatedly due to muscle traction. In the case of fragments, the task is complicated, so often you have to turn to surgical treatment. The tactics of surgical intervention are determined taking into account the radiography of the forearm. Osteosynthesis is possible.
A comminuted fracture of the beam in a typical area is also a common occurrence. Usually observed displacement of fragments. The wrist joints are deformed, swollen, and movements are sharply hindered. Crepitus is uncharacteristic. Radiography reveals a fracture with the presence of a different number of fragments. In most cases, the displacement is eliminated during a closed reposition; in some situations, osteosynthesis of the beam metaepiphysis with knitting needles or a plate is necessary.
Pelvic fracture
Pelvic fractures of the pelvis form with intense traumatic action (road injuries, falls from a considerable height), often go in conjunction with a violation of the continuity of the ring and are severe damage, which is accompanied by the development of traumatic shock. Damage to the anterior and posterior half rings, lateral masses of the sacrum and acetabulum is not excluded. Doctors reveal a pronounced pain syndrome. The movements are very limited, among other things, support on the legs is impossible, observe the forced position of the limbs, which depends on the type of fracture. Diagnosis is based on pelvic radiography. When displaced carry out skeletal traction.
Fragmented hip fracture
Such an injury occurs in the lower third, less often in the skewer area. Cellular cervical fracture is observed very rarely. Damage is usually accompanied by pain, swelling, deformation and the occurrence of painful mobility. Support is not possible. With intraarticular damage, hemarthrosis is determined. The diagnosis is specified on the basis of thoracic radiography.
Therapy
The treatment of fractures in this case is more often conservative, using skeletal traction. In case of unstable damage, osteosynthesis is performed with curved plates or spongy screws. Treatment of diaphyseal fractures can be carried out conservative (skeletal traction) or surgical. Surgical intervention is prescribed to patients if it is impossible to properly match the fragments due to interposition of soft tissue.
Comminuted fracture of the tibia
Fragmented leg fracture in the leg region is a common injury that results from jumping from a certain height or hitting the leg. It often turns out to be a consequence of car accidents (bumper fractures). Damage to the lower sections often occurs when limbs are tucked. Against the background of intraarticular fractures of the upper third, pain is noted along with hemarthrosis, significant swelling and deformation of the knee joint. Crepitus may be completely absent. Such fractures are accompanied by sharp pains, deformation, failure of the axis of the limb, and pathological mobility. I may experience deformation in combination with severe swelling of the ankle joint.
Surgical treatment of shrapnel fractures of the lower leg is more often performed. Doctors perform osteosynthesis of the tibia with screws. With a diaphyseal fracture, skeletal traction can be used for four weeks, in the subsequent healing process occurs in a plaster cast. However, due to the difficulty of comparing a significant number of fragments and the need to prevent contractures nowadays, with such injuries, surgical methods are increasingly used in the form of osteosynthesis of lower leg bones with screws or pins.
Ankle fracture
When ankle fractures, doctors usually follow conservative tactics. In the event that it is not possible to compare the fragments during a closed reposition, resort to osteosynthesis with a plate or a tensioning loop. Sometimes transarticular fixation with needles is carried out.
Spinal fracture
Is there a fragmentation fracture of the spine? Let's figure it out.
Such an injury is very rare (in only twelve percent of cases) and is one of the most severe fractures. Pathology got its name due to the fact that fragments of bone that can injure the spinal cord, nerves or blood vessels break off from the vertebrae. A variety 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 the therapy, conservative treatment is performed. 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.
Fractures of the finger and heel - detailed description
With a fragmented heel fracture, as in previous cases, fragments are formed. Conservative treatment is required. But besides this, with such injuries, as a rule, skeletal traction is applied for the damaged finger. To eliminate heel injury, surgery is performed in the form of an open reduction and knee osteosynthesis. Fragmented fracture of the finger heals faster.
Complication
In patients with such fractures, especially with multiple and combined trauma, with open injuries of the bones of the pelvis or hips, fat embolism may occur along with traumatic toxicosis, anemia. Fractures in elderly patients are very often complicated by pneumonia, and in individuals who suffer from alcoholism, acute psychosis is likely.
With open fractures (especially with extensive tissue damage), suppuration of the wound in combination with osteomyelitis is possible. Late complications include delayed bone fusion and the formation of a false joint. In addition, abnormal 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 treatment very seriously and follow all the doctor's recommendations, as otherwise adverse complications are possible.