COMMON TYPES OF FRACTUREA presentation by Rowell Angeles

COMMINUTED FRACTURE

Definition

A comminuted fracture is a fracture in which the bone involved in the fracture is broken into several pieces. At least three separate pieces of bone must be present for a fracture to be classified as comminuted. This type of fracture can be challenging to treat due to the complexity of the break, and it can be especially complicated if the fracture is open, meaning that the bone is protruding outside the skin. Open fractures are at a very high risk of infection and they typically take longer to heal.

BACKGROUND

Comminuted fractures are also sometimes known as multi-fragmentary fractures. This type of fracture often involves crushing or splintering of the bone, and it can occur anywhere along the length of the bone. A comminuted fracture is most common in elderly people or in people with conditions which weaken the bones, such as osteogenesis imperfecta or cancer. A comminuted fracture can also occur as the result of tremendous force, such as a car accident or a severe fall.

Like many other types of fracture, comminuted fractures are associated with very distinctive symptoms which usually lead people to seek medical treatment. The patient usually experiences tremendous pain at the site of the fracture, and he or she may even pass out at the time that the break occurs as a result of the pain. The area around the break will also swell, and it may become warm to the touch. Typically the patient cannot bear any weight on the fracture without experiencing significant pain.

BACKGROUND

This type of fracture is usually easy to diagnose with an X-ray to look at the site of the suspected fracture. When a comminuted fracture is X-rayed, the doctor can use the image to gather more about the orientation of the pieces of bone and the location of the fracture to determine the best possible treatment. It may be necessary to pin the fracture with surgery so that the pieces will have a chance to knit together.

Complications of comminuted fractures can include infection, compartment syndrome, vascular necrosis, and nonunion, in which the pieces of bone fail to join together. Usually someone with a comminuted fracture will need to attend several follow up appointments at the office of an orthopedic doctor to confirm that the fracture has been set properly, and that it is healing appropriately. If the healing does not appear to be progressing as desired, the doctor can intervene to address the issue.

SPIRAL FRACTURE

DefinitionA spiral fracture is a

type of bone fracture which is caused by a twisting force. You may also hear spiral fractures referred to as torsion fractures, in a reference to the forces involved to create a spiral fracture. Because the break is helical, it can be difficult to treat a spiral fracture, involving months in a cast and possible surgery, depending on the location of the break, the general health of the individual, and the specific circumstances involved in a fracture.

BACKGROUND

A classic example of a spiral fracture is a fracture incurred while skiing. Because skiers lock their feet into the skis in sturdy ski boots, if a ski breaks or the skier loses control and the ski rotates, the leg may be violently twisted in one direction, creating a textbook spiral fracture. As anyone who has broken a leg skiing knows, this type of spiral fracture can be extraordinarily painful, and it typically quashes any skiing activity for several months, at least.

To diagnose a spiral fracture, a doctor will take x-rays of the site and examine them. The x-rays will confirm that the issue is a fracture, and a close examination of the x-ray will provide information about what kind of fracture is involved. Depending on the situation, the doctor may recommend surgery to pin the fracture, ensuring proper healing in the event of a severe break, or the limb may simply be set in a cast to hold it still while the fracture heals.

BACKGROUND

You don't need much torsion to create a spiral fracture, especially in the case of people with fragile bones due to age or poor diet. In the event that you do not have immediate access to medical care, as might be the case when you are camping, you should immobilize any suspected fracture with a splint to keep the patient comfortable while you transport him or her to a hospital.

The spiral fracture has become famous as a warning sign of abuse, especially in children, because the twisting motion necessary could be caused by something such as a parent or guardian grabbing and twisting the arm or leg of a child. When doctors see spiral fractures in children, it may set off warning bells; in the event that you take your child to the hospital for a broken bone and it is diagnosed as a spiral fracture, do not be offended if the doctor asks some searching questions. These questions are asked out of concern and to confirm the cause of the fracture, because the doctor wants to make sure that your child is safe.

GREENSTICK FRACTURE

DefinitionA greenstick fracture is a type

of mild bone fracture which is most commonly seen in children. In a greenstick fracture, extreme force causes a bone to bend, breaking partway through, much like a green twig when it is bent. The prognosis for this type of fracture is generally good, with some greenstick fractures healing in as little as three weeks when they are promptly diagnosed and treated. Many children break a limb at some point due to their active lives, and a greenstick fracture is typically nothing to be concerned about, although it

does require medical treatment.

BACKGROUND

A common cause of a greenstick fracture is a fall, as falls can cause a bone to bend further than it is able too. Blunt trauma such as a blow can also cause such a fracture. The name “greenstick fracture” really is apt, because the best illustration of this fracture involves picking up a young twig and bending it; you will notice that part of the twig breaks, generally not very cleanly, while the other side stays whole, although it may be stressed from the bending process.

Treating a greenstick fracture requires reducing the fracture, typically by pulling the bone apart slightly and then pushing it into place to straighten it out. To ensure that the fracture heals, the doctor will put the affected limb into a cast, immobilizing it so that the bone can grow back. Healing times for greenstick fractures are often very quick, and these fractures are typically not as painful as some other types of fractures, especially once the fracture has been reduced. Anti-inflammatory drugs may be prescribed to bring down swelling at the fracture site.

BACKGROUND

The main risk of a greenstick fracture is that it could go undiagnosed. It is often possible to put weight on the limb, for example, although it may be painful, and the fracture may be dismissed as a simple hard blow, resulting in some swelling but no lasting damage. If a child falls or takes a serious blow and complains of pain which seems a bit extreme, you may want to go to the hospital to rule a greenstick fracture out, especially if the area of the injury swells rapidly. Failure to treat the fracture could result in a very painful infection and permanent damage to the site.

Most greenstick fractures heal completely after being reduced and placed into a cast. However, in some instances, the fracture will not heal properly, requiring surgery. This is extremely rare, especially when the fracture is addressed as quickly as possible and weight is kept off the bone while it heals.