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?

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.

Types

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)

Symptoms

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.

Causes

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)

Diagnosis

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.

Treatment

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.

Casting

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)

Prognosis

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)

Recovery

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

References

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