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Home > What is a Segmental Fracture and How is it Treated?

What is a Segmental Fracture and How is it Treated?

Boyd W. Haynes III, MDBoyd W. Haynes III, MD

segmental fracture is one where there are at least two fracture lines in a bone and a “segment” of separated bone in-between those fracture lines. Sometimes these medical definitions make sense!   They typically happen in the long bones of the arms and legs but can happen elsewhere in the body. In this article, I’ll detail the causes, symptoms and how this fracture is treated.

A segmental fracture is typically caused by a high energy impact, such as could occur in a motor vehicle crash, being ejected from a vehicle or falling from a height. None of these scenarios are desirable and often result in multiple injuries, some of which may be life-threatening and take treatment priority over the bone fractures.  Almost always, these fractures will be first evaluated by an ER or Trauma physician, if available.

The symptoms of a segmental fracture are:

  • Severe pain (if patient is conscious)
  • Inability/difficulty moving the affected body part
  • About half may present as a compound fracture also (bone or bone fragments will protrude through the skin)
  • Swelling, bruising, redness
  • Deformed or misshapen body part

The patient will be sent for a series of CT scans, x-rays, and MR scans to determine the extent of their injuries and to help the trauma team prioritize what injuries need to be handled first. Once any cardiac, vascular, and respiratory issues are seen to and the internal organs are taken care of, then I would get my turn.  The trauma team would have splinted the broken bone(s) to immobilize them and prevent further damage, but any further treatment would be left up to the orthopaedic surgeon.

In an earlier article this month, I referenced how skeletal traction isn’t used much anymore; however, in this type of fracture/trauma scenario, it may be optimal in the very short term.  Often, with segmental fractures, there is quite a bit of internal soft tissue trauma that happens from the bone breaks, that causes edema and tissue inflammation.  The muscles, ligaments and tendons may have violently contracted during the trauma and pulled the fractured bones far out of alignment.  Due to all these factors, slow and steady traction might be just the ticket to give the anti-inflammatory medications time to work, allow the patient’s injuries to start healing and to pull the bones back into alignment.

While that is going on, the patient may also be healing from other life-threatening lung, liver or brain injuries, just to give a few examples.  When the patient is stable, I can do surgery and implement the internal fixation (rods, screws, wires, plates, etc.) to reduce the fractures, decontaminate the field of debris (if an open fracture), and close it up with sutures or glue.

If the patient has no other pressing injuries at that time, they can go home from the hospital and begin the process of healing these fractures.  For leg fractures, there will be no weight bearing, but I will prescribe range of motion exercises to keep up strength and lessen muscle atrophy.  For arm fractures, again range of motion exercises will be crucial. Once the fractures have healed, Physical Therapy will begin in earnest to improve strength and range of motion, regain muscle and in some cases, function.  Thankfully, most patients should recover fully, however, those who are athletes may find their performance lessened after this injury.

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