Comminuted fractures occur when the surface of the bone is obstructed in its continuity in more than one line, resulting in more than two bone fragments. More stiff than the bones can tolerate
The comminuted fracture is classified as a complete fracture according to the pattern of its fracture and according to its mode of production it can belong to both direct and indirect production process (bending) groups. It can be classified as a Comminuted fracture with a butterfly piece and a sectional fracture.
Butterflies are characterized by fragments wed on the other hand the sectional communicated fracture is characterized by the fact that the rest of the surface of the fracture separates a portion of the bone in two lines.
In the Gustilo classification, the comminuted fracture is usually located in III grade; However in some cases of moderate commination it can be classified as second grade.
A common complication of this bone fracture is the obstruction of vascularization of bone fragments and, consequently, its necrosis. Healing these fractures slowly, sometimes to avoid complications, and to find small pieces in order to favor osteosynthesis between healthy pieces and their proper integration.
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Signs and symptoms of Comminuted fracture
In general, the symptoms of a Comminuted fracture are not different from the symptoms of other fractures.
Pain in a Comminuted fracture is usually more intense than pain in a normal fracture; It occurs at multiple sites due to periosteal involvement and this periosteum contains a large number of painful nociceptors.
However, pain is a subjective symptom that is difficult to establish from a history of pain alone whether it is a common fracture or a Comminuted fracture.
In addition to the pain, the remaining symptoms of Celsus are also present in these types of fractures: increase in size and edema due to microvascular, erythema, heat and loss or loss of function.
Apparently the upper part of the distortion and aggregation is the cryptus which will lean towards clinical diagnosis and will require complementary studies for imaging diagnosis.
Comminuted fractures can only be diagnosed through imaging studies. Where the number of bone marks and sections obtained from trauma can be proven.
A simple X-ray analysis of one or more projections of the section, depending on the location of the injury. It is sufficient to show the comminution of the fracture.
In some less frequent cases, a computed tomography is required to be able to observe bone fragments, especially if it occurs intramuscularly.
Reasons of Comminuted fracture
The causes of Comminuted fractures are not distinct from common fractures; however, some conditions can occur in this type of fracture, especially those that refer to the location of the injury.
Frequent causes of comminuted fractures include conditions or pathologies that weaken bone structure.
Osteomalacia, osteopenia, osteoporosis, cancer and tumors in incomplete osteogenic conditions. The bone structure will be so compromised regardless of the patient’s age that trauma caused by a lack of severity can “explode” the bone.
Aging is the age group with the greatest propensity for Comminuted fractures due to aging structural changes of bone cells. It impairs bone integrity.
Joint fractures are characteristic of fractures that come from direct projectile trauma to automobile accidents or from great heights.
These types of severe direct trauma fractures are known as secondary projectiles that can produce. It refers to bone or protruding fragments that explode at the moment of impact and can damage adjacent tissues.
Comminuted fracture Treatment
Treatment The most difficult aspect of Comminuted fractures difficult in the past; these types of fractures were treated with conservative orthopedic procedures such as traces and incisions.
However, due to the complexities arising from prolonged immovable or incorrect integration, the search for other solutions becomes significant.
The use of osteosynthesis material to fracture bones with each other. As well as surgical treatment of Comminuted fractures is required. The technique used will depend on the location of the fracture and the amount of fragments obtained from it.
The use of external stabilization of the Ilizarov type is ideal for fractures. The loss of bone material is significant; However, the risk of infection through fixator is quite high.
Ilizarov surgery is a method of bone lengthening that is used in cases of lost bone tissue as well as congenital bone defects.
There are two stainless steel rings along the ends of healthy bones that go through the skin, muscles and bone tissue through this Ilizarov surgery. These are fixed when the non-vascularized bone fragments are removed.
A minimum space is created between the two ends of the healthy bone tissue. And the space is widened by 1 mm per day, so that new bone tissue is formed between the two ends.
This technique is extremely painful. And with a high risk of soft tissue infection if it is not performed in the right environment and with strict care. However, it is one of the most widely used techniques in orthopedic and trauma services in South America.
In some synthetic fractures of the humerus in elderly patients with slightly functional demands on bone structure. Some doctors consciously decide to ignore this fracture (a technique called efficient negligence). And focus on the mobility of the entire underlying joint.
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