Prognosis
The prognosis for bone fragmentation depends on a number of different factors. In particular, the localization of the bone piece as well as its size and a possible impairment of other structures play a role. If there are also other injuries and complete bone fractures, these also have an influence on the healing process. In most cases, however, the prognosis can be considered very good. Although healing takes a relatively long time, as bones only grow together slowly and achieve complete stability, affected persons are usually free of symptoms after healing.After viewing the images, the treating physician can usually provide information about the individual assessment of the course of the disease.
Prophylaxis
Prophylaxis to prevent bone splintering is difficult to recommend. Sudden injuries can only be prevented to a limited extent. In contact sports, care should be taken to wear adequate body protection. Furthermore, in the case of bone splintering that occurs without a massive force being applied, the bone density should be measured if necessary to check the bones for sufficient stability and thus prevent further bone splintering.
Localization of a bone fracture
A bone splintering in the area of the foot or ankle joint (“ankle”), as in the other parts of the body, occurs in the vast majority of cases as a result of an injury. The most common injury mechanisms are the ankle joint bending either outwards or inwards and traffic accidents in which the foot is pinched or crushed. Another situation that can often lead to bone splintering in the foot is when an opponent steps on the foot of the person affected, e.g. during soccer.
Two special cases of bone splintering in the foot area are the Volkmann fracture and the pilon tibial fracture, both of which can occur in the context of an ankle fracture (“ankle fracture“). The former is a splintering of the so-called Volkmann triangle, a wedge-shaped bone fragment from the posterior tibia. The pilon-tibial fracture, on the other hand, describes the breaking off of a bone fragment from the articular surface of the tibia, which is why the follow-up treatment of a pilon-tibial fracture is usually much more complicated than that of a Volkmann fracture.
The treatment of a bone fracture in the foot or ankle can be either conservative or surgical. If there are no other injuries (e.g. bone fractures or ligament injuries) and if the splintered bone fragment is located so favorably that it will probably grow back to the remaining bone even without surgical refixation, surgery is usually not necessary. However, the surgeon must intervene in the event of concomitant injuries to the ligaments or if the bone fragment is severely displaced.
An important characteristic of bone splinters in the area of the foot or ankle joint is the constant strain on this part of the body in everyday life. This is why it is particularly difficult and time-consuming to take care of this area after the surgical treatment of the bone fracture. Many patients do not have the necessary patience in the post-treatment of the bone splintering and thus endanger the maintenance of the success of the therapy.
If the patient starts too early with excessive stress, incomplete healing of the fracture may occur. In addition, the pain that occurs can force the patient to adopt an incorrect posture of the foot, which in turn can lead to incorrect loading of other areas of the foot, which are then subjected to greater loads to relieve the fracture area. In this way, a vicious circle of chronic ankle problems can develop.
The mechanism described thus makes it clear why consistent and long-term rehabilitation is particularly important in the case of bone splintering in the foot or ankle. Bone splintering in the knee area is usually caused by direct exposure to violence, e.g. during sports or traffic accidents. Patients usually complain of severe pain and often also of limited joint mobility.
Bone splintering in the knee is usually treated surgically, especially if it is accompanied by other injuries, such as broken bones or ligament injuries. If, on the other hand, the chipped-off piece of bone is only slightly displaced and there are no accompanying injuries, a non-surgical therapy can also be considered. Osteochondrosis dissecans is a special case of bone splintering in the knee.
Here, a small area of bone below the joint cartilage slowly dies off, probably due to reduced blood flow. In advanced stages, this bone area can become loose and splinter off into the joint capsule as a so-called “joint mouse”. In most cases, however, this complication can be avoided by consistently protecting the knee joint.The most important distinguishing features compared to the other types of bone splinters in the knee are the slowly progressive increase in pain intensity and the occurrence without a sports or other accident as an acute cause of injury, as well as conservative therapy in the form of sparing.
A bone splintering in the finger area is usually a sports injury. It is often caused by a failed attempt to catch a heavier ball or by the ball hitting the tip of the outstretched finger. In addition to bone splintering, it can also lead to dislocation of a finger joint.
Bone splinters in the finger can also be treated conservatively or surgically, depending on their severity. Since fingers are very delicate parts of the body, great importance should be attached to good healing of the bone splinter. If there is an accompanying injury to one of the finger tendons, this is of great importance.
Injuries to the flexor tendons in particular must always be treated surgically, as otherwise the gripping ability of the finger may be permanently impaired. A special feature of bone splintering on the finger is the constant strain on the fingers in everyday life. This makes it particularly difficult for the patient to adhere to the period of rest required after the treatment.
However, since insufficient protection can lead to long-lasting complaints and thus jeopardize the success of the therapy, a high level of discipline on the part of the patient is the key to success here. A bone splinter in the thumb is usually the result of accidents in everyday life or sports. It occurs particularly frequently with goalkeepers in ball sports, with volleyball or basketball players or in the context of a so-called “ski thumb“.
In the case of a “ski thumb“, the outer collateral ligament in the metacarpo-phalangeal joint of the thumb tears in the context of a skiing accident due to the leverage effect of the thumb ligament of the ski pole, which leads to an unnaturally strong spreading of the thumb. In more unfortunate cases, this ligament rupture is associated with bone splintering. In addition to unspecific signs such as pain and swelling, an increased ability to spread is typical for the ski thumb, which is normally limited by the torn collateral ligament.
In addition, patients find it difficult to hold objects between thumb and index finger. Since the rupture of the collateral ligament alone – possibly after surgical treatment – requires several weeks of immobilization, the bone splintering is also optimally treated in this way. Only in the case of a complicated, i.e. severely displaced bone splinter, should surgery be performed to ensure that the bone piece can grow back to the remaining bone without complications.
However, bone splintering in the thumb can also occur independently, without connection to a ski thumb. It is based on similar injury mechanisms as the ski thumb. In most cases, surgical therapy is not necessary, and after four to six weeks of immobilization, the bone fragments should have healed sufficiently for the thumb to be able to cope with everyday stress, before the patient can return to risky sports such as skiing or basketball after about 3-4 months.
The Rolando fracture can be considered a special form of bone splintering in the thumb. It is usually the result of accidents similar to the injuries described above and refers to a fracture within the metacarpo-phalangeal joint of the thumb in combination with the splitting off of a piece of bone due to the pulling effect of a muscle tendon that has just been attached there. Strictly speaking, although the Rolando fracture is a metacarpal fracture, it should be considered a possible concomitant injury when diagnosing a bone splinter in the thumb due to the similar complaints and injury mechanisms.
- Ski thumb and
- Torn capsule on thumb
