Traumatic bone injuries: the dislocated fracture
Compound fracture: what does it mean? A bone fracture is an injury of traumatic or pathological origin, which can affect any part of the skeleton
There are different types of fractures and it is possible to classify them on the basis of their aetiology or on the basis of the positioning of the stumps following the injury event.
In particular, a displaced fracture is a type of injury in which the fracture of the bone leads to the formation of two or more bone segments that migrate from their physiological position; it is a very delicate condition that requires special attention from the medical staff.
When a patient suffers a displaced fracture, it is extremely important to intervene promptly in order to fully restore the functionality of the affected area: if not treated properly, in fact, a fracture can lead to a series of even serious complications.
The treatment of a fracture generally involves immobilising the injured area with external braces or internal containment devices.
As far as healing time is concerned, a compound fracture can take between 2 and 16 weeks to heal completely.
Bone fractures: what they are and what they are due to
A bone fracture is a skeletal injury that involves the total or partial fracture of a bone.
When the bone is injured, two or more fragments may form, which are called fracture stumps; the space created between them is called the fracture rhyme.
In the case of a decomposed fracture, the fracture stumps are displaced from their physiological position and therefore require realignment.
The fracture of a bone can occur as a result of different injury mechanisms, which can be by bending, torsion, compression or avulsion.
In bending fractures, the fracture is caused by an unnatural curvature of the bone, while in the case of torsion fractures, the bone undergoes an abrupt rotational movement; compression fractures occur when the spongy tissue of a bone is crushed between the diaphysis and the joint cavity.
Tear fractures or avulsion fractures, on the other hand, are caused by violent muscle contractions that result in bone detachment at the tendon insertion of the affected muscle.
What are the causes: trauma fractures and pathological fractures
A dislocated fracture can have several causes: traumatic, pathological or stress fracture.
In detail:
- Traumatic fractures: a fracture can be the consequence of a traumatic event, such as an accident, blow, fall, etc. To result in a fracture, the traumatic event must have such a force that it exceeds the resistance limits of the bone structure (high-energy trauma): the trauma may be of the direct type, in the case where a fracture occurs at the very point where the force is applied, or it may be of the indirect type, in the case where the fracture occurs at a certain distance.
- Pathological fractures: certain pathological disorders can weaken the bone structure and undermine its resistance, such as in the case of bone tumours, osteomyelitis, conditions of osteopenia or osteoporosis, or osteogenesis imperfecta (also known as Lobstein’s disease); in these cases, the force required to originate the fracture is significantly reduced (low-energy trauma), and in some cases spontaneous failure of the diseased bone can also occur.
- Stress fractures: also called duration fractures, these can occur when a certain area of the body is subjected to continuous stress, which over time results in the reoccurrence of micro-trauma and micro-lesions on a healthy bone.
Main symptoms
Patients who suffer a displaced fracture may present symptoms of varying intensity, depending on the type of trauma, the severity of the damage sustained and the body area affected.
In general, it is a particularly painful condition, as it involves stimulation of the nerve endings responsible for receiving pain, i.e. the nociceptive ones.
In many cases, patients may be subjected to traumatic shock that results in asthenia, lipotimia, syncope, low blood pressure, tachycardia and dyspnoea precisely because of the intense pain.
The main symptoms associated with a decompensated fracture are:
- Pain and shock;
- Reduced mobility of the injured area;
- Inability to use the part affected by the trauma, i.e. functional impotence;
- Swelling and oedema, due to the swelling of the inflammatory reaction of the surrounding tissues;
- Ecchymosis and haematomas, due to the rupture of blood vessels in the subcutaneous tissue;
- Haemorrhage, particularly in the case of decomposed and exposed fractures;
As already mentioned, if appropriate measures are not taken quickly, bone fractures can be prone to complications that can undermine the patient’s health.
First of all, nerve injuries can occur: if a nerve is compressed under a bone fragment for a long time, or due to an accumulation of fluid in the tissue surrounding the fracture, the patient may experience sensory and motor paralysis, which impairs the function of the affected area.
Furthermore, if the fractured area is not immobilised in time, there is a risk that the bone will not heal properly, leading to deformity and permanent pain.
In this regard, it should be emphasised that it is absolutely inadvisable to attempt manoeuvres to fix the injured limb, to move the patient, or to massage the affected area, in order to avoid aggravating the damage.
Finally, fractures present a high risk of causing thromboembolic phenomena, which, by entering the bloodstream, can affect the patient’s neurological, pulmonary and cardiac functions, as in the case of fat embolisms, venous thrombosis and pulmonary embolisms.
To this end, preventive measures are taken by prescribing the patient a drug therapy based on anticoagulants.
Classification of fractures
Bone fractures may present different characteristics according to which it is possible to propose a distinction into different types of fractures.
Displaced fracture or compound fracture
A first distinction concerns the possible movement of the stumps resulting from the injury: as already mentioned, in decomposed fractures the bone segments undergo a displacement with respect to their anatomical seat and, therefore, the stumps will lose their physiological alignment; depending on the movement that the fragments make, there can be lateral, angular, longitudinal or rotational fractures.
If, on the other hand, the fracture does not cause any alteration in the habitual position of the bones, the fracture is called a compound fracture, and usually has a faster and smoother course.
Exposed fracture or closed fracture
If the fracture causes a tear in the skin, it is called an exposed fracture, in which the bone stumps and underlying tissues protrude to the outside; an exposed fracture presents numerous risks to the patient, as it is a very unstable injury that increases the risk of bleeding as well as infection.
If, on the other hand, the skin covering the bone remains intact following a trauma, we speak of a closed fracture; it should be borne in mind, however, that even in the case of closed fractures, internal bleeding or other complications can occur.
Simple fracture or multiple fracture
Depending on the injured area, it is possible to distinguish between complete fractures, in which the entire bone segment is lacerated, and incomplete fractures, which only affect a portion of the bone.
In addition, depending on the type of trauma, the bone may be damaged to different degrees: if the injury causes a detachment into two separate segments, we have a simple fracture; if, on the other hand, the injury originates several bone fragments, we have a multi-fragmentary or comminuted injury, in the case of several fracture rims.
Diagnosis and treatment of a comminuted fracture
The diagnosis of a dislocated fracture is based on a series of specific tests, i.e. X-ray, CT scan and MRI: these tests are essential in order to accurately establish the type of fracture, location and extent of the lesion.
Generally speaking, the treatment of a fracture involves, first of all, immobilising the area subject to trauma.
In the case of a displaced fracture, the ends of the bone must be realigned to aid the healing process.
This procedure is called reduction surgery, and can be performed by external manipulation, closed reduction or surgery.
Once the bone fragments have been realigned, they must be held in place either by external braces such as plaster and splints, or by internal restraints such as plates, metal nails and intramedullary screws.
The duration of immobilisation depends on the fractured bone, the presence of possible complications, the age of the patient and the type of injury: on average, the fracture is immobilised for at least 2-8 weeks.
If a broken bone has been properly aligned and is kept immobile, the healing process is usually simple and occurs spontaneously, through the formation of temporary callous tissue that is gradually transformed into new bone by the action of osteoblasts.
What to do if the fracture does not heal?
In some cases the bone may struggle to heal or consolidate completely, and the fragments of the lesion are joined by a soft tissue for healing: the failure of a fracture to heal is called pseudoarthrosis.
There are several treatments that can be used to resolve this condition, they include: ultrasound therapy, bone grafting or stem cell treatment.
After fracture consolidation, it may be necessary to restore muscle strength and function to the affected area through physiotherapy.
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