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Managing Comminuted Fractures: Surgery, Casts, and Therapy


Can learning about comminuted fracture symptoms and repair help individuals and healthcare providers develop effective treatment and rehabilitation programs?

Managing Comminuted Fractures: Surgery, Casts, and Therapy

Comminuted Fractures

A comminuted fracture is a severe break in which the bone splits into at least three pieces. Comminuted fractures typically happen in the long bones like those in the arms and legs. But they can also happen in other places, including the ribs. (Corinne Tarantino, 2022) They are usually caused by intense impact, like an automobile collision/accident or a severe fall. Depending on the location of the fracture, recovery from a comminuted fracture can take months and often involves:

  • Surgery – A surgeon will place screws and rods to hold the pieces of the bone in position. Sometimes, the hardware is left in permanently. (American Academy of Orthopaedic Surgeons, 2021)
  • Wearing a cast for several months.
  • Physical therapy.


In these types of fractures, the bone is completely broken, not just cracked. The break is a highly comminuted fracture if the bone is broken into four or more pieces. (Corinne Tarantino, 2022)


The symptoms are the same as those of other broken bones, but they can be more intense because the bone is broken in multiple areas, which means there may also be more soft tissue injuries than with a simple fracture. Broken bone symptoms include: (MedlinePlus, 2024)

  • Persistent pain
  • Swelling
  • Bruising
  • Deformity – the bone looks out of place or is at an odd angle.
  • Tingling
  • Numbness
  • Difficulty moving the limb.


An intense force causes a comminuted fracture, often a car accident or a hard fall, but it can also result from sports injuries. (Corinne Tarantino, 2022)


A comminuted fracture is diagnosed by X-ray, which shows where the bone has broken and how many pieces it has split into (MedlinePlus, 2024). Healthcare providers will diagnose any broken bones but also look for other injuries.


Typically, broken bones can be treated with casts, braces, or a boot to keep them immobilized. (MedlinePlus, 2024) Because comminuted fractures are more severe, they often need other treatments, including surgery. Sometimes, the bone can be reset instead of surgery using a closed reduction technique, where the healthcare provider resets the bone manually. Surgery may be recommended if that’s not possible or doesn’t work.

Types of Surgery

Surgery allows the healthcare provider to correctly position all the pieces of the bone to heal in a strong, stable formation. The two types commonly used to treat comminuted fractures are: (American Academy of Orthopaedic Surgeons, 2021)

External Fixation

  • This surgery uses rods and screws outside the body to stabilize the bone.
  • This external frame is placed during surgery and later removed.

Open Reduction Internal Fixation – ORIF

  • During this surgery, the bone is stabilized with metal plates, screws, rods, and/or wires placed inside your body.
  • Sometimes, these are permanent, but in other cases, they are removed later.
  • An orthopedic surgeon performs these surgeries.


After surgery, a cast is usually needed to prevent the bone from moving and allow healing. Typically, the cast is worn for six to eight weeks, but it may need to be worn longer with comminuted fractures. Some need a cast for several months (American Academy of Orthopaedic Surgeons, 2021). Sometimes, those with an external fixation must continue wearing a cast after removing the pins and rods, giving the bone more time to stabilize. The healthcare provider will inform the patient how long the cast will need to be worn and which sports activities should be avoided even after the cast comes off.

Physical Therapy

The healthcare provider may recommend physical therapy to help treat the fracture. Usually, when the cast is removed, physical therapy is activated to help rebuild strength and range of motion. (Corinne Tarantino, 2022)


Although these fractures are severe, they are treatable. The prognosis is good for individuals who follow their healthcare provider’s treatment plan. Most don’t have lingering pain after the initial injury and can eventually return to regular activities. (American Academy of Orthopaedic Surgeons, 2021)


Healing a comminuted fracture can take months. During that time, it’s helpful to focus on tasks that can be accomplished, like new hobbies that don’t involve physical injury. Talk to the healthcare provider about any problems with the cast or ongoing pain and what to expect during recovery.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help individuals return to normal. Our providers create personalized care plans for each patient. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

The Path to Healing Personal Injury


Corinne Tarantino, MPH. Osmosis. (2022). Comminuted Fracture: What is it, Examples and More. www.osmosis.org/answers/comminuted-fracture

Throckmorton T.W. American Academy of Orthopaedic Surgeons. (2021). Fractures (broken bones). orthoinfo.aaos.org/en/diseases–conditions/fractures-broken-bones/

MedlinePlus. National Library of Medicine. (2024). Fractures Also called: Broken bone. Retrieved from medlineplus.gov/fractures.html

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Professional Scope of Practice *

The information herein on "Managing Comminuted Fractures: Surgery, Casts, and Therapy" is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional.

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Our information scope is limited to Chiropractic, musculoskeletal, physical medicines, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somatovisceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and/or functional medicine articles, topics, and discussions.

We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system.

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Dr. Alex Jimenez DC, MSACP, RN*, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
Texas DC License # TX5807, New Mexico DC License # NM-DC2182

Licensed as a Registered Nurse (RN*) in Florida
Florida License RN License # RN9617241 (Control No. 3558029)
License Compact Status: Multi-State License: Authorized to Practice in 40 States*
Presently Matriculated: ICHS: MSN* FNP (Family Nurse Practitioner Program)

Dr. Alex Jimenez DC, MSACP, RN* CIFM*, IFMCP*, ATN*, CCST
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