Introduction
Closed fractures are called so based on their anatomical involvement of the skin. If the broken bone lies within the skin, it is said to be a closed fracture. These fractures are most favorable in treatment as they show minimal displacement and lesser contamination due to non-exposure to the environment. This type of fracture is seen commonly in both children and adults.
What Is a Fracture?
A fracture is a break or discontinuity along the continuity of the bone disrupting the structure of the bone. Fractures can be classified into multiple types based on location, cause, crack pattern, and skin anatomy. It can be classified in the following ways:
1. Based on Single Fracture Line:
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Transverse fracture.
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Longitudinal fracture.
2. Based on Multiple Fracture Line:
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Greenstick fracture.
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Segmental fracture.
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Spiral fracture.
3. Based on Cause:
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Stress fracture or hairline fracture.
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Avulsion fracture.
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Impacted fracture.
4. Based on Intact Skin:
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Closed fracture.
What Is a Closed Fracture?
Closed fractures are fractures that lie within the skin's surface or a fracture in which the skin is not torn without exposing the bone. The different types of closed fractures are:
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Greenstick Fracture: Greenstick fractures are fractures where one side appears cracked and bent while the other is stuck or intact, appearing like a broken greenstick. It is commonly seen in children as their bones are softer and weaker.
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Transverse Fracture: Transverse fractures commonly affect long bones where the fracture line is perpendicular to the bone. The bones primarily involved are the tibia, femur, fibula, humerus, radius, and ulna. They also affect the spine, resulting in a transverse fracture, the leading cause of lower back pain.
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Spiral Fracture: Spiral fracture is a type of fracture occurring when the bone gets broken in a twisted manner. These fractures are seen in patients with weaker bones and in children whose bones are softer than adults. It occurs during regular activities like walking and running as the cause mainly stresses on more fragile bones.
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Oblique Fracture: Oblique fractures are straight-line fractures where the fracture line runs in an angulated line along the length of the bone. These occur as complete fractures commonly involving long bones. It is caused by a fall or trauma and takes longer to heal.
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Compression Fracture: Compression fractures occur in patients with much less bone density, as in the case of osteoporosis. The fracture happens to fragile bones. It is a common fracture involving the vertebrae.
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Comminuted Fracture: Comminuted fractures occur as fractures where the bone is broken into multiple pieces. It is a very complex type of fracture and needs numerous treatment approaches. This fracture occurs due to high-impact accidents like automobile accidents. Treating this fracture is risky as it can involve excessive tissue loss, leading to a compromised blood supply and causing infection.
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Segmental Fracture: Segmental fractures are uncommon, with two different fracture lines and high complication rates. The healing of these fractures is also unclear and delayed compared to non-segmental fractures. These fractures are commonly caused by vehicle accidents, falling from a roof or ladder.
How Does a Closed Fracture Occur?
The conditions which commonly cause a closed fracture are:
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Hit.
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Vehicle accidents.
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Physical abuse.
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Malnutrition.
How Is a Closed Fracture Seen Clinically?
A closed fracture may show the following clinical features:
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Pain - The patient is seen with extreme pain after the fall or accident.
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Swelling - Swelling becomes an evident symptom in clinically differentiating fractures.
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Visible Deformity - In the fracture of extremities, visible structural deformity is seen.
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Warmth - The site of injury becomes warm due to the accumulation of fluid.
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Redness.
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Purplish Bruises.
How to Diagnose a Closed Fracture?
Diagnosis of a closed fracture is essential as the wound is within the skin's surface. The diagnosis of a fracture can be tricky, but it is crucial to decide on the diagnosis and treatment plan. There are various diagnostic methods used for the diagnosis of these fractures, and they are:
Clinical Diagnosis:
Clinical diagnosis is the first line of diagnosis and is always of great importance. Clinical diagnosis includes:
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Proper case history.
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Knowing the patient's past and current medical details.
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Communicating about the cause of the injury.
The symptoms are assessed to rule out other conditions like a foot sprain or a tumor that shows similar clinical signs.
Radiographic Investigation (X-Ray): X-rays of the fractured area are taken to determine the type of fracture, its location, treatment protocol, and prognosis.
Magnetic Resonance Imaging (MRI): The MRI scan is used to study the associated tissues, ligaments, tendons, arteries, and nerves supplying the region.
Computed Tomography (CT): CT scans are taken to confirm the presence of fracture line
It is three-dimensional imaging and shows a clear margin of the fractured segment.
How to Treat Closed Fractures?
Closed fractures can be treated in the following ways:
1. Conservative Management:
As the fracture lies on a closed surface, it is impossible to treat it without surgery. But in cases with minimally cracked bones, immobilization can be achieved using plaster bandages to allow healing. The blood flow is maintained by keeping the body slightly elevated.
There are five principles given by Hippocrates in the year 400 BC for treating bone. The principles used for treating a bone fracture are as follows:
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Antisepsis - Cleaning or sterilizing the wound to get rid of the bacteria or any infectious agents.
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Reduction - Reducing the fractured segment to its original position.
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Traction - It is achieved by agents which help in giving force to bring the broken piece together.
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Bandaging - Bandages are wrapped around the wound with medication to prevent the contamination of the wounded area.
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Splinting - Splinting the fracture is achieved by using external splints or braces that hold the broken fragment in the desired position until healing occurs.
The conservative treatment, splints, and braces can be provided along with NSAID (non-steroidal anti-inflammatory drugs) for almost eight to ten months.
2. Surgical Management: The surgical management of closed fracture takes place by three methods, reduction, fixation, and immobilization:
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Reduction: It is the process of reducing the deformity or the distance between the fractured unit to the standard structure and attaching it. The reduction can be achieved by two methods: open and closed reduction. Where closed reduction is treating the fracture in a nonsurgical manner, an open reduction is made by opening the skin and approaching the broken bone.
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Fixation: In surgical Management, fixation is done by holding the repaired or broken area in the desired place and fixing the bone using internal or external fixations. Internal fixation is done using plates, screws, or rods placed under the skin, and in external fixation, devices like braces are fixed over the skin.
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Immobilization: The main purpose of fixation is to hold the bone in place and to aid in healing. Immobilization is performed after the surgery using plaster casts that have the repaired area in place.
3. Rehabilitative Management: This is done through physiotherapy and strengthening exercises provided under a guided therapist, followed by periodic checkups.
What Are the Complications of Closed Fracture?
The complications occurring after the management of closed fractures are
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Wound Contamination: Wound contamination is one of the most commonly occurring complications seen in a closed fracture.
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Delayed healing.
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Dislocation.
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Closed fractures should be ruled out from sprains, concussions, and injury to the ligaments or tendons.
Conclusion
A closed fracture is a clinical condition that involves most types of fractures. These fractures always show favorable healing in a closed environment with minimal displacement. The treatment measures taken are usually successful.
