Simple (Closed) Bone Fracture: Definition, Diagnosis & Management
A simple (closed) fracture = broken bone with intact overlying skin. No external wound communicates with fracture hematoma.
Contrast with Compound (Open) Fracture
| Feature | Closed | Open (Gustilo-Anderson) |
|---|
| Skin | Intact | Lacerated/punctured |
| Infection Risk | Low (~1–2%) | High (Grade I 1–2%, III 10–50%) |
| Soft Tissue Injury | Variable (contusion, swelling) | Often severe |
| Urgency | Urgent (hours) | Emergent (OR within 6h for antibiotics/irrigation) |
Diagnosis
- History: Mechanism, deformity, neurovascular status
- Exam: Swelling, ecchymosis, deformity, tenderness, crepitus, pulses, sensation, motor
- Imaging: X-ray (AP/lateral ± oblique); CT for intra-articular/complex; MRI for occult/stress
Management Principles
- Reduction (closed) if displaced/angulated
- Immobilization: Splint → cast/brace
- Elevation, ice, analgesia
- Neurovascular monitoring
- Follow-up X-rays (1–2 wks) for redisplacement
- ORIF if unstable, intra-articular, failed closed reduction
Complications
- Compartment syndrome (emergency)
- Malunion, nonunion, stiffness, post-traumatic arthritis
- CRPS (chronic pain syndrome)
Closed fractures generally heal well with appropriate immobilization and rehabilitation.
Bone Fractures - Related Articles
