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What is a segmental fracture?
Segmental fractures are a type of broken bone. They happen when one of your bones is broken in at least two places, leaving a segment of your bone totally separated by the breaks. These fractures can affect any long bone in your body. Some of the most common include:
- Femur (thigh).
- Tibia (shin).
- Fibula (calf).
- Humerus (upper arm).
- Radius and ulna (forearm).
- Clavicle (collarbone).
Segmental fractures are almost always caused by serious traumas like car accidents or falls from high places. They’re very serious, and you’ll likely need surgery to repair your bones. How long it takes to recover fully depends on which of your bones are fractured — and what caused the breaks. Most people need around a year to recover from a segmental fracture.
Segmental fractures vs. comminuted fractures
Segmental fractures and comminuted fractures are both serious types of bone fractures. They’re different terms that tell your healthcare provider specific details about how your bones are broken, where they broke and what they look like inside of your body right now.
Segmental fractures happen when your bone is broken in two different places and a section of your bone has separated from the rest of it because of the fracture. Comminuted fractures mean your bone is broken in three or more places. This means some segmental fractures can be comminuted, and some are not.
No matter which names and terms are applied to your fracture, the most important first step is getting your injury examined by a healthcare provider as soon as possible.
Who gets segmental fractures?
Segmental fractures — like all bone fractures — can affect anyone. This is especially true because they’re caused by serious traumas. There’s no way to predict when or how someone will be in an accident, so everyone could experience a segmental fracture.
How common is this condition?
Segmental fractures are rare. This is because they’re caused by severe traumas that most people fortunately never experience.
Symptoms and Causes
What are the symptoms of a segmental fracture?
If you have a segmental fracture, you’ll also likely experience serious symptoms of the trauma that caused it. Your symptoms will depend on the other injuries you have. But in general, the symptoms of a segmental fracture can include:
- Intense pain.
- Not being able to move a part of your body that you normally can.
- A part of your body being noticeably different looking or out of its usual place.
- Seeing your bone through your skin.
Open vs. closed fractures
Your healthcare provider will classify your fracture as either open or closed. If you have an open fracture, your bone breaks through your skin. Open fractures usually take longer to heal and have an increased risk of infections and other complications. Closed fractures are still serious, but your bone doesn’t push through your skin.
What causes segmental fractures?
Segmental fractures are caused by trauma. Some of the most common causes are car accidents and falls from great heights, like off a ladder or roof.
Any impact to your bones can cause a segmental fracture. However, slips, falls and other common causes of broken bones aren’t usually strong enough damage to your bones to cause a segmental fracture.
Diagnosis and Tests
How are segmental fractures diagnosed?
Your healthcare provider will diagnose a segmental fracture with a physical exam and imaging tests. In some cases, this may be done in the emergency room (ER) if you’re admitted after a trauma.
If you’re taken to an ER, a team of healthcare providers will work to stabilize you and treat your injuries in the order of severity, especially if some are life-threatening. After you’re stabilized, you’ll need imaging tests to confirm your fracture.
What tests are done to diagnose a segmental fracture?
You’ll need at least one of a few imaging tests to take pictures of your fracture:
- X-rays: An X-ray will confirm any segmental or other fractures, and show how damaged your bones are.
- Magnetic resonance imaging (MRI): Your healthcare provider might use an MRI to get a complete picture of the damage to your bones and the area around them. This’ll show them tissue around your bones, too. This is especially important to determine how your muscles, connective tissue and organs were affected by the trauma.
- CT scan: A CT scan will give your healthcare provider or surgeon a more detailed picture of your bones and the surrounding tissue than an X-ray.
Management and Treatment
How are segmental fractures treated?
Almost all segmental fractures are treated with surgery. There are a few techniques used to repair segmental fractures, and which one your surgeon uses will depend on your injuries, which bone is fractured and any other complications after your trauma.
Your surgeon will realign (set) your bones to their correct position and then secure them in place so they can heal and grow back together. They usually perform what’s called an internal fixation, which means your surgeon inserts pieces of metal into your bone to hold it in place while it heals. Internal fixation techniques include:
- Rods: A rod inserted through the center of your bone that runs from top-to-bottom.
- Plates and screws: Metal plates screwed into your bone to hold them in place.
- Pins and wires: Pins and wires hold pieces of bone in place that are too small for other fasteners. They’ll typically be used at the same time as either rods or plates.
Some people live with these pieces inserted in them forever. You might need follow-up surgeries to remove them.
You might need an external fixation. This is often a temporary solution that stabilizes your fracture while your other injuries heal. Your surgeon will put screws on either side of the fracture inside your body, then connect them to a brace or bracket around your bone on the outside of your body.
Surgeons sometimes recommend external fixation as a first step before more invasive surgeries to fix your segmental fracture. If you have lots of other injuries, your body might need time to regain its strength to be able to tolerate internal fixation surgeries. Your surgeon might also use external fixation to stabilize your bone while they’re waiting for swelling inside your body to go down.
On their own, segmental fracture surgeries are outpatient procedures, which means you might be able to go home the same day. However, it’s likely the trauma that led to your segmental fracture caused other injuries that’ll require you to stay in the hospital to recover.
After your surgery, the part of your body with the fractured bone in it will be immobilized. Depending on where this is, you’ll need some combination of a brace, splint or cast before you can start putting any weight on it again or using it as you did before your injury.
What medications are used to treat segmental fractures?
Over-the-counter NSAIDs like aspirin or ibuprofen can lead to bleeding and other complications after surgery. Your surgeon will talk to you about the medications you can take to reduce pain after your surgery.
Complications of segmental fracture treatment
Segmental fracture surgery complications include:
- Acute compartment syndrome (ACS): A build-up of pressure in your muscles may stop blood from getting to tissue, which can cause permanent muscle and nerve damage.
- Malunion: This happens when your broken bones don’t line up correctly while they heal.
- Nonunion: Your bones may not grow back together fully or at all.
- Bone infection (osteomyelitis): If you have an open fracture (the bone breaks through your skin), you have an increased risk of bacterial infection.
- Other internal damage: Fractures can damage the area around your injury, including your muscles, nerves, blood vessels, tendons and ligaments.
Side effects of NSAIDs include:
- Stomach pain.
- Bowel complications.
How soon after treatment will I feel better?
It might take a few weeks for your symptoms to improve. Depending on which type of surgery you had to repair your segmental fracture — and which bones were broken — you should be able to start moving again in a few weeks.
If you experience intense pain that doesn’t get better, contact your healthcare provider.
How can I reduce my risk for segmental fractures?
Follow these steps to reduce your risk of injury throughout your daily routine:
- Always wear your seatbelt.
- Wear the right protective equipment for all activities and sports.
- Make sure your home and workspace are free from clutter that could trip you or others.
- Always use the proper tools or equipment at home to reach things. Never stand on chairs, tables or countertops.
- Follow a diet and exercise plan that will help you maintain good bone health.
- Talk to your healthcare provider about a bone density test if you’re older than 50 or if you have a family history of osteoporosis.
How can I prevent a segmental fracture?
Because segmental fractures happen suddenly, it’s often impossible to prevent them completely. You can’t predict when you’ll experience a trauma, so there isn’t anything you can do to prevent a segmental fracture.
Outlook / Prognosis
What can I expect if I have a segmental fracture?
If you have a segmental fracture, you’ll have a longer road to recovery than people who get other types of broken bones. It might take up to a year to heal, especially if you have other injuries from your original trauma.
You’ll need physical therapy to regain strength and range of motion in the part of your body that was injured. This therapy will be part of your larger recovery plan from other injuries.
How long does it take a segmental fracture to heal?
Segmental fractures take longer to heal than other kinds of broken bones. They’re also much more likely to involve complications. You’ll likely need to work with healthcare providers at a trauma center or other specialized facility.
Most segmental fractures take around a year to heal. The exact time it takes your bone(s) to heal will depend on the severity of your fracture and if you develop any complications.
Will I need to miss work or school?
If you experience a trauma, you’ll likely need to miss work or school while you recover. Your specific injuries and which bones are fractured will impact how long you’ll need to miss work, school and other activities.
Talk to your surgeon or healthcare provider before resuming any physical activities while you’re recovering.
Outlook for a segmental fracture
Segmental fractures are very serious injuries. If you experienced other injuries during the original trauma, your life might be impacted forever. Because the traumas that cause segmental fractures are often life-threatening accidents, it’s tough to separate one from the other. Talk to your healthcare provider about your customized healing plan, and what to expect as you heal from your trauma.
When should I go to the emergency room?
If you think you have a segmental fracture — or any other broken bone — you need to see a healthcare provider as soon as possible. Go to the emergency room if you experience any of the following:
- Intense pain.
- You can’t move a part of your body that you normally can.
- A part of your body is noticeably different looking or out of its usual place.
- You can see your bone through your skin.
- New bruising that appears at the same time as any of these other symptoms.
Go to the emergency room right away if you’ve experienced a trauma.
What questions should I ask my doctor?
- Which bones are fractured?
- Which type of surgery will I need?
- Will I need follow-up operations?
- How long will it take to recover?
A note from Cleveland Clinic
Segmental fractures occur during traumas that can be life-threatening. The scariest part of these injuries is that you can’t usually prepare for them. The good news is that surgeries to repair segmental fractures have very high success rates. Recovering from a major injury can seem like an insurmountable job, but take your healing journey one step at a time, and celebrate your progress as you go.
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