Displaced Fracture: Types, Causes, Symptoms, Treatment, Recovery Period, Diagnosis

Displaced fracture is a type of fracture, in which a bone breaks into two or more parts and the bones get displaced from their original position.¹ The alignment of the bone is disturbed due to a displaced fracture and the broken parts of bone no longer remain in a straight line. While there can be various causes of displaced fracture, it is important to know the symptoms and diagnose a displaced fracture.

Fractures that cause a break in the bone, can be of different types, mainly a non-displaced and a displaced fracture. A non-displaced fracture usually results from a crack or break in the bone, but the broken parts of bone remain in alignment and do not move from their place. However, in displaced fracture, the parts of bone not only break but also move from their place and don’t remain correctly aligned.

Displaced fracture often results from trauma and is a very painful condition. As the broken parts of bones move from their place, the sharp edges can cause damage to the neighboring structures or internal organs. This makes displaced fracture a serious condition, which must be assessed carefully. Proper diagnosis of displaced fracture is important to ensure proper management. Timely treatment of displaced fracture is essential and may be a little challenging too.

Displaced fracture can be a very complicated condition and there can be many causes of displaced fracture. Trauma and multiple injuries are the commonest causes of displaced fracture. Fracture is often a result of exposure to a stronger pressure than what a bone can sustain. Displaced fracture may occur when the force exerted on the bone is very powerful and possibly in a direction that can cause displacement of the fractured bone.

Some of the common causes of displaced fracture include

Vehicular accidents, falls, direct blows or fights can cause displaced fracture. Sports injuries or direct trauma in adventure sports is also a common cause of displaced fracture, which can result in considerable pain and discomfort.

Another possible cause of displaced fracture is breaking of weak bones. Bones can become weak due to underlying pathological conditions like osteoporosis, disorders of the bones or old age. People taking certain type of medications for a long period may also be at increased risk of developing osteoporosis and weak or brittle bones. Such brittle bones can easily break even when slight force is applied or due to falls and cause a displaced fracture.

Displaced fracture can result in severe damage to the nearby structures or internal organs, depending on the type of fracture. There are various types of displaced fracture, which need to be understood as they play an important role in deciding the treatment plan.

Different types of displaced fractures can be noted in clinical practice. The types are categorized considering the relation of one broken part of the bone to the other. These parts are also termed as distal and proximal parts of the bone.

Some of the common types of displaced fracture includes:

• A rotated fracture, where the broken bone turns around or rotates, either external or internal.
• An angulated fracture, this is a type of displaced fracture where the broken bone ends move from their alignment and form an angle with each other. If the broken part of bone forms an angle on the inner side or medial angulation, it is called varus and if the angle is on the outer side or lateral angulation, it is called valgus.
• Displacement and shortening fracture is noted when the broken part of bone, gets displaced and moves towards the upper part of bone, reducing the total length of the bone. Shortening type of displaced fracture occurs more often in an oblique fracture.
• Distraction and impaction are also types of displaced fracture. Distraction or widening occurs when the broken parts of bone get spaced out, widened causing distraction, which increases the overall length of the bone. Impaction occurs when the broken parts of bone get jammed into each other, while they may remain normally aligned.

A combination of these types of displaced fracture can also be seen, which commonly include angulation and rotation or angulation, rotation and shortening along with displacement in displaced fracture.

Another important type of fracture includes open and closed fracture, which can also be seen as types of displaced fracture. Open fracture is a fracture in which the broken parts of bone cut through the skin and an open wound can be noted over the skin. A closed fracture in displaced fracture is a fracture in which the broken parts of the bone remain inside and the overlying skin is intact, leaving no noticeable injury to the skin.

Displaced fracture mainly presents with a history of injury, fall or blow to the area, which can result in breaking of the bone. The symptoms of displaced fracture include pain and swelling in the area of the fracture. Small protrusion or noticeable disfigurement is a common symptom of displaced fracture, which is usually not seen in other non-displaced types of fracture.

Depending on the bone involved, symptoms of displaced fracture may also include inability to move the bone, inability to bear weight or hold any weight. If the lower limbs are affected, walking may be difficult, painful or not possible. If the upper limbs are affected in a displaced fracture, the hand movements, lifting of objects and other activities of the hand may be affected.

Open wounds and injury to the skin may be noticed in some cases of displaced fracture. This is seen in open fractures, in which the broken bone fragments protrude through the skin, causing injury and can be seen from outside.

If the displaced fracture causes injury to the internal parts, there may be severe pain, bleeding and other complications of the parts. If a displaced fracture causes impingement of nerves, it can cause numbness and tingling or burning sensation in the arms or legs or in areas nearby the fracture. Loss of sensation in the area supplied by the nerve or inability to move or function the part is also a possible symptom of displaced fracture.

These symptoms of displaced fracture too need to be considered, in view of possible complications of displaced fracture.

Evaluation of a displaced fracture and assessment of the symptoms of displaced fracture is necessary to be able to begin with appropriate first aid and treatment of displaced fracture. A thorough clinical history and physical examination is necessary to understand the type of injury and the type of displaced fracture. Clinical examination in displaced fracture can often reveal injury to the skin and open wounds in case of open fracture. Bony prominence or sharp parts of broken bone can be felt through the skin. Bruising or bleeding, swelling may be noted in the area of the fracture in displaced fracture.

Considering the types of displaced fracture, clinical examination may reveal difference in the length of the bone on the other side of the body, leg length discrepancy or shortening of leg in case of angulation or shortening type of displaced fracture. Instability and difficulty in moving the affected parts is assessed with the view to plan further investigations and treatment.

Investigations for the diagnosis of displaced fracture include, X-rays of the bone to detect displaced fracture. It may also help to determine the type of displaced fracture or additional bone scans may also be done. CT scan of the bone around the injured area can help to accurately detect the injury, type of displaced fracture, severity and extent of the injury. MRI may be done to detect soft tissue injuries in the areas surrounding the displaced fracture.

Some cases of displaced fracture may need immediate medical attention and appropriate first aid treatment to prevent complications of displaced fracture.

The main aim of treatment of displaced fracture is to provide first aid to the wound, preserve the bone parts and prevent further damage to them and protect other structures from getting injured.

First aid management includes treating open wounds in a displaced fracture. This usually includes cleaning, dressing and debridement of wound with necessary medications and anti-septic precautions. Medicines as a part of treatment of displaced fracture include analgesics and anti-inflammatories to manage pain, swelling and inflammation from injury. Anti-biotics may be given depending on the type of wound to prevent infections. Vaccines like anti-tetanus toxoid may be considered depending on the type of injury causing the displaced fracture.

Treatment for displaced fracture usually includes immobilization using splints, casts or traction and reduction is mostly performed to re-align the bone fragments. As in displaced fracture, the bone parts get displaced, it is necessary to bring them back to their original position, which is done in reduction. Reduction as a treatment in displaced fracture is a procedure, which is done to close or re-align the broken bones in a displaced fracture. It can be done as closed reduction, which may not require surgery to treat displaced fracture, or it may be treated surgically as open reduction.

Surgery for displaced fracture may be planned in some cases of displaced fracture where the injury is severe, there is large degree of displacement, it is an open fracture with severe injuries or there are non-healing wounds in displaced fracture.

Most cases of displaced fracture, if treated properly in time, may heal well within 4 to 6 months. However, it also depends on the type of displaced fracture, the area and the bones involved and the severity and extent of the injury. Treatment of displaced fracture must be followed by proper rehabilitation, which plays an important part in recovery.

Physical therapy plays a crucial role in treatment of displaced fracture, after reduction or surgical correction. Physical therapy for displaced fracture aims at normal healing of wound, regaining normal movements, joint flexibility and muscle strength. Regular physical therapy is necessary to be able to resume normal functions of the bone and joints after having experienced a displaced fracture.

Some complications of displaced fracture may include injury to the soft tissues, nerves or blood vessels in the surrounding area. Mal-union and non-union of fractures, infection, avascular necrosis and osteopenia are also some of the common complications of displaced fractures. In some cases, displaced fracture may also need to be corrected with a secondary surgery to ensure proper alignment of bone parts or in cases of complications. General health, age and medical history, too plays an important role in healing of injuries and recovery in displaced fracture.

Proper timely treatment and appropriate rehabilitation can help in complete recovery in displaced fracture. It is necessary that emergency cases of displaced fracture receive immediate medical care, correct diagnosis and prompt treatment to prevent complications of displaced fracture.

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