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Displaced Fracture: Causes, Symptoms & Treatment

A displaced fracture is a bone break in which the bone fragments have shifted out of their normal position. It usually requires targeted medical treatment.

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A displaced fracture is a bone break in which the bone fragments have shifted out of their normal position. It usually requires targeted medical treatment.

What Is a Displaced Fracture?

A displaced fracture is a type of bone fracture in which the broken bone fragments are no longer properly aligned. Instead, they have shifted, rotated, or angled away from their original anatomical position. This distinguishes it from a non-displaced fracture, where the bone breaks but the pieces remain correctly aligned.

Displaced fractures can occur in virtually any bone in the body and are a common finding in trauma surgery and orthopedics.

Causes

Displaced fractures typically result from direct or indirect mechanical force applied to the bone. Common causes include:

Falls from height or onto hard surfaces
Traffic accidents involving high-impact forces
Sports injuries, especially in contact sports
Direct blows to the bone
Pathological fractures in weakened bone, such as in osteoporosis, bone metastases, or bone tumors

The displacement is often driven by muscle forces acting on the fragments after the break, as well as the direction of the original impact.

Types of Displacement

Medical professionals classify displacement based on its direction and nature:

Translation: The fragments are shifted sideways relative to each other.
Angulation: The fragments form an angle, resulting in an axis deviation.
Rotation: One fragment is twisted relative to the other.
Distraction: The fragments are pulled apart along the bone axis.
Impaction: One fragment is driven into the other.

Symptoms

Displaced fractures typically cause significant symptoms, including:

Severe, immediate pain at the site of injury
Visible deformity or abnormal shape of the affected limb or body part
Swelling and bruising (hematoma) around the injury site
Limited range of motion or complete inability to move the affected area
Possible crepitus (a grating sensation or sound upon movement)
In severe cases: injury to blood vessels, nerves, or soft tissue

Diagnosis

The diagnosis of a displaced fracture is established through clinical examination and imaging studies:

X-ray: The standard method for visualizing fractures and assessing the degree of displacement. Images are typically taken in two planes (anteroposterior and lateral).
Computed Tomography (CT): Used for complex fractures or pre-surgical planning.
Magnetic Resonance Imaging (MRI): Particularly useful for evaluating soft tissue injuries, ligament damage, and cartilage involvement.
Ultrasound: Used in select cases, particularly in children, as a supplementary diagnostic tool.

Treatment

Treatment of a displaced fracture depends on the location, degree of displacement, bone quality, and the overall condition of the patient. The primary goals are to realign the bone fragments and maintain that alignment until healing is complete.

Conservative Treatment

In certain cases, non-surgical management may be sufficient:

Closed reduction: Manual realignment of the bone fragments without surgery, typically performed under anesthesia or sedation.
Immobilization: Following reduction, the bone is held in place with a cast, splint, or functional brace.
Pain management: Use of analgesics and anti-inflammatory medications to control pain and swelling.

Surgical Treatment

More severely displaced fractures, those involving joints, or unstable fracture patterns often require surgical intervention:

Open Reduction and Internal Fixation (ORIF): Surgical realignment of fragments followed by fixation using screws, plates, nails, or wires.
Intramedullary nailing: Insertion of a metal nail into the medullary canal of the bone to provide stabilization, commonly used for long bone fractures.
External fixation: Stabilization of fragments using an external frame, particularly when significant soft tissue injury is present.
Joint replacement (arthroplasty): In cases of severe periarticular fractures, a prosthetic joint may be implanted.

Rehabilitation

After stabilization, targeted physiotherapy is essential to restore range of motion and strength, prevent muscle atrophy, and support full functional recovery.

Complications

Displaced fractures may lead to several potential complications, including:

Malunion: The bone heals in an incorrect position
Non-union (pseudarthrosis): Failure of the bone to heal, resulting in a false joint
Vascular or nerve injury
Compartment syndrome: Elevated pressure within a muscle compartment compromising blood flow
Infection following surgical treatment
Osteoarthritis when a joint surface is involved

References

Meinberg, E.G. et al. - Fracture and Dislocation Classification Compendium 2018. Journal of Orthopaedic Trauma, 32(Suppl 1), S1-S170 (2018). PubMed PMID: 29256945.
Court-Brown, C.M. et al. (eds.) - Rockwood and Green's Fractures in Adults. 9th edition. Wolters Kluwer Health (2020).
World Health Organization (WHO) - Injuries and Violence: The Facts. WHO Press, Geneva (2014). Available at: www.who.int

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