Comminuted Fracture

Overview

What is a comminuted fracture?

Comminuted (pronounced “kah-meh-noot-ed”) fractures are a type of broken bone. The term comminuted fracture refers to a bone that is broken in at least two places. These fractures can affect any large or 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).
  • Skull.

Comminuted fractures are almost always caused by serious traumas like car accidents or falls from a high place. They are very serious in large bones, and you will often need surgery to repair your bones. Sometimes, comminuted fractures happen to smaller bones and can heal without surgery. How long it takes to recover depends on which of your bones are fractured and what caused the breaks. Most people need up to a year to recover from a comminuted fracture if it involved one of the long or larger bones in your body, especially if it requires surgery.

Comminuted fractures vs. segmental fractures

Comminuted fractures and segmental fractures are both serious types of bone fractures. They are different terms that tell your healthcare provider specific details about how your bones are broken, where they broke and what they look like inside your body right now.

If you have a comminuted fracture your bone is broken in two or more places. Usually, the trauma that causes comminuted fractures creates shatter-like breaks. If you’ve dropped a plate, the pieces are never uniformly broken. It’s the same with most comminuted fractures.

Segmental fractures happen when a bone is broken in two different places and a section of the bone has separated from the rest of the bone because of the fracture. Some segmental fractures are comminuted, and some are not.

No matter which names and terms end up applied to your fracture, the most important first step is getting your injury examined by a provider as soon as possible. If you have either a comminuted or segmental fracture, you’ve likely experienced a serious injury either way and getting your injuries assessed by a provider is the only way to determine which treatments you’ll need.

Who gets comminuted fractures?

Comminuted 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 comminuted fracture.

How common is this condition?

Comminuted 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 comminuted fracture?

If you have a comminuted 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 comminuted fracture can include:

  • Intense pain.
  • Not being able to move a part of your body you normally can.
  • A part of your body is noticeably different looking or out of its usual place.
  • Seeing your bone through your skin.
  • Swelling.
  • Bruising.

Open vs. closed comminuted 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 are sometimes also called compound fractures. 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 does not push through your skin.

Displaced comminuted fractures

Displaced or non-displaced are more words your provider will use to describe your fracture. A displaced fracture means the pieces of your bone moved so much that a gap formed around the fracture when your bone broke. Non-displaced fractures are still broken bones, but the pieces weren’t moved far enough to be out of alignment during the break. Displaced fractures are much more likely to require surgery to repair. Comminuted fractures are more likely to be displaced than other types of broken bones because they always have multiple broken pieces.

What causes comminuted fractures?

Comminuted fractures are caused by trauma. Some of the most common causes are car accidents and falls from a great height, like off a ladder or roof.

Any impact to your bones can cause a comminuted fracture. However, slips, falls and other common causes of broken bones aren’t usually strong enough damage to your bones enough to cause a comminuted fracture.

Diagnosis and Tests

How are comminuted fractures diagnosed?

Your healthcare provider will diagnose a comminuted fracture with a physical exam and imaging tests. In some cases, this may be done in the emergency room if you’re admitted after trauma.

If you’re taken to an ER, a team of 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 will need imaging tests to confirm your fracture.

What tests are done to diagnose a comminuted 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 comminuted or other fractures, and show how damaged your bones are.
  • Magnetic Resonance Imaging (MRI): Your provider might use an MRI to get a complete picture of the damage to your bones and the area around them. This will 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 provider or surgeon a more detailed picture of your bones and the surrounding tissue than an X-ray.

Management and Treatment

How are comminuted fractures treated?

You’ll need surgery to repair a comminuted fracture if one of your long or large bones is broken. There are a few techniques used to repair comminuted 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. You’ll probably need pins and wires to hold the pieces of your bone together after your comminuted fracture.

Some people live with these pieces inserted in them forever. You might need follow-up surgeries to remove them.

External fixation

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 the bone outside your body.

Surgeons sometimes recommend external fixation as a first step before more invasive surgeries to fix your comminuted 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.

Bone grafting

You might need bone grafting if your comminuted fracture is severely displaced or if your bone isn’t healing back together as well as it should. Your surgeon will insert additional bone tissue to rejoin your fractured bone. After that, they’ll usually perform an internal fixation to hold the pieces together while your bone regrows. Bone grafts can come from a few sources:

  • Internally from somewhere else in your body — usually the top of your hip bone.
  • An external donor.
  • An artificial replacement piece.

On their own, comminuted 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 comminuted fracture caused other injuries that will 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 like you did before your injury.

What medications are used to treat comminuted 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 comminuted fracture treatment

Comminuted 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 the injury including your muscles, nerves, blood vessels, tendons and ligaments.

Side effects of NSAIDs include:

  • Bleeding.
  • Ulcers.
  • 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 comminuted 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.

Prevention

How can I reduce my risk for comminuted 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 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 comminuted fracture?

Because comminuted 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 comminuted fracture other than basic safety precautions. If you use a walker or a cane to help you walk, you should never walk without them and be very careful on uneven surfaces.

Outlook / Prognosis

What can I expect if I have a comminuted fracture?

If you have a comminuted 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 will 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 comminuted fracture to heal?

Comminuted fractures take longer to heal than other kinds of broken bones. They’re also much more likely to involve complications.

Most comminuted fractures take around a year or longer 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 will 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 comminuted fracture

Comminuted 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 comminuted fractures are often life-threatening accidents it’s tough to separate one from the other. Talk to your provider about your customized healing plan, and what to expect as you heal from your trauma.

Living With

When should I go to the emergency room?

If you think you have a comminuted 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.
  • Swelling.
  • 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

Comminuted fractures are very serious injuries. You may not know you have one until after you’ve been treated as a result of the trauma that hurt you. Even though it’s scary to find out you have a broken bone — especially a severe one — treatment for comminuted fractures has a very high success rate. Your healthcare provider and surgeon will guide you along your road to recovery.

Last reviewed by a Cleveland Clinic medical professional on 12/27/2021.

References

  • American Academy of Orthopaedic Surgeons. Fractures (Broken Bones). (https://orthoinfo.aaos.org/en/diseases--conditions/fractures-broken-bones/) Accessed 12/27/2021.
  • American Academy of Orthopaedic Surgeons. Internal Fixation for Fractures. (https://orthoinfo.aaos.org/en/treatment/internal-fixation-for-fractures/) Accessed 12/27/2021.
  • MedlinePlus. Broken bone. (https://medlineplus.gov/ency/article/000001.htm) Accessed 12/27/2021.
  • Merck Manual. Overview of Fractures. (https://www.merckmanuals.com/professional/injuries-poisoning/fractures/overview-of-fractures) Accessed 12/27/2021.
  • Radiopaedia. Comminuted Fracture. (https://radiopaedia.org/articles/comminuted-fracture?lang=us) Accessed 12/27/2021.
  • Sun Y, Sheng K, Li Q, Wang D, Zhou D. Management of comminuted patellar fracture fixation using modified cerclage wiring. (https://pubmed.ncbi.nlm.nih.gov/31623684/) J Orthop Surg Res. 2019 Oct 17;14(1):324. Accessed 12/27/2021.

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