The neuromuscular skeletal system is frequently injured in motor vehicle accidents. Broken bones or fractures happen all the time to folks injured in high-speed car accidents, motorcycle accidents, and truck accidents.
Successful treatment of a fracture starts with a timely and accurate diagnosis. The diagnosis depends on proper x-rays of the area.
Types of Fractures
The type of the break gives us some idea about the potential recovery time and long term consequences. Below is a list of common fractures:
- Simple or Closed Fracture: This is a break in the bone that does not communicate with the outside environment. In other words, it doesn’t break the skin. Most closed fractures can be easily set and treated with immobilization, bracing or casting.
- Compound or Open Fracture: This is a break in the bone that goes through the skin over the fractured bone. Compound fractures are more serious because the bone displaced far enough to travel through and disrupt the skin. Many times these fractures require surgical intervention to put the bones back in place.
- Comminuted Fracture: This is a break that contains two or more bony fragments that have separated. The more pieces of broken bone, the more difficult a comminuted fracture is to treat. Many times a surgeon has to go into the area and remove some of the bone fragments.
- Non-Comminuted Fracture: This is a break that goes completely through the bone.
- Incomplete Fracture: This is a break on one side of the bone that leaves a buckling or bending of the bone as the only x-ray sign of the fracture. These types of fractures have other names such as Greenstick. A Greenstick fractures happens to young children and infants because their bones are still soft.
- Avulsion Fracture: This is a fracture that occurs when a portion of the bone is torn away by a muscle or ligament. In automobile accidents we typically see avulsion fractures in the lower part of the neck, when the interspinous ligament pulls away from the spinous process. This is called a Clay Shoveler’s fracture. Another frequent location for avulsion fractures is the ankle. Many times the driver’s ankle can get caught under the brake pedal, causing one of the ligaments to pull away and chip (avulse) the bone.
- Impaction Fracture: This is a fracture that occurs when a portion of a bone is driven into another portion of a bone. In car accidents we see these fractures at the tibial plateau or hip, when the person’s lower extremity or lower leg is impacted by the dashboard and/or floor board.
Cervical Spine Fractures – Neck Fractures
The main purposes for the bones in the neck are support/structure and protection of the nervous system. If a fracture is unstable, it can damage the spinal cord cause loss of function and severe disability. We will start at the top of the neck and move towards the bottom of the neck.
- C1 – Jefferson/Burst: Is a fracture of the ring of the top vertebrae in the neck called the atlas. This fracture usually occurs when a person jams his/her skull into something hard. We see these fractures if a passenger’s head is jammed into the roof in a vehicle that has rolled over, and in swimming pool accidents when a person dives into shallow water.
- C2- Hangman’s Fracture: Is a fracture of the second vertebrae in the neck. Automobile accidents are the most common cause of these fractures. The mechanism of injury is usually a quick deceleration from high speed that causes hyperextension of the neck. The action on the neck causing injury is the same as hanging on a gallows. We see these fractures when vehicles are propelled into walls in the median or sides of highways.
- C2 – Odontoid (Dens) Fractures: The dens is part of the second vertebrae that sticks up like a thumb nail. This fracture is common in cervical spine trauma and accounts for about one-half the fractures of the second cervical vertebrae. The specific location of this fracture will dictate the Victim’s potential recovery.
- C3-C7 – Articular Pillar Fractures: The articular pillar is also called the facet joint. This is one of the most commonly missed cervical spine fractures because it requires a special x-ray view. The most common site of this fracture is the mid to lower neck. These fractures are usually the result of motor vehicle accidents. You may also hear the term perched facet, which means the joint dislocates along with the fracture. These fractures can be very dangerous and typically require surgery to decompress the spinal cord and stabilize the spine.
Mid-Back – Thoracic Spine Fractures
- Compression Fractures: In the thoracic area of the spine. Compression fractures usually come from axial trauma. Like the burst type fractures in the neck. The forces are usually from a very strong blow to the top of the head.
- Rib Fractures: Ribs are frequently fractures from trauma in motor vehicle accidents. The mechanism is usually from a seat belt or console.
- Sternal Fractures: The sternum or chest bone usually fractures because of contact with the steering wheel. In some extreme cases, this injury can bruise the heart.
- Clavicle Fractures: The collar bone will fracture because of the seat belt or the shoulder hitting the door or B-pillar.
Low Back – Lumbar Spine Fractures
- Compression Fractures: These fractures are one of the most common in the low back. The mechanism of injury is usually axial compression with flexion. In a car accident, the patient will provide a history of being thrown out of the seat and slamming their head into the top of the vehicle.
- Transverse Process Fracture: This is an avulsion fracture of the little bone that sticks out of the side of the vertebrae. In a car accident, the patient will usually report that their low back struck the seat, the center console, or they were thrown from the front seat to the back seat.
- Chance or Lap Belt Fracture: This is a fracture that goes across the vertebrae from front to back. The mechanism of injury is usually forceful flexion over a lap belt. The patient’s internal organs can be injured by the force.
- Bucket Handle Fracture: This is a fracture of the lower part of the pelvis and usually occurs in automobile accidents or pedestrian versus automobile collisions.
Complications Associated with Spine Fractures:
- Damage to the spinal cord causing quadraplegia (loss of function in the arms & legs) or paraplegia (loss of function in the legs)
- Surgical fixation of the vertebral segments to stabilize the vertebrae
- Non-union of the bone
Fractures of the hip have been reported in motor vehicle crashes when the hip hits the car or the leg is jammed into the floorboard of the car vehicle.
The most common complication of a hip fracture is avascular necrosis of the hip. Avascular necrosis is death of the bone because the blood supply to the area has been disrupted. Avascular necrosis can cause serious disability and usually requires the patient to undergo a hip replacement (total hip arthroplasty).
Fractures of the Knee will occur in an automobile accident because the knee gets jammed under the dashboard. In a slip & fall, the injury usually occurs because the knee hits strikes the ground. The following are common fractures in the knee area:
- Tibial plateau – also known as a bumper or fender fracture. The tibial plateau is flat part of the lower leg bone (tibia) that articulates with the femur (long leg bone).
- Fibula fracture – the fibula is the outer bone of the lower leg and will fracture when pressure is placed in that area. The fibula fractures when the outside of the leg strikes something in the vehicle like the door.
- Patella (knee cap) fracture – usually happens when the knee is jammed under the dashboard in a car accident or when the patient falls directly on the knee cap.
Ankle Fractures & Dislocations are also frequent injuries in car accidents. During the crash, the Victim will usually explain that their foot was on the the brake pedal or twisted under the brake pedal. Common ankle fractures include:
- Medial Malleolus Fracture – inside ankle bone
- Lateral Malleolus Fracture – outside ankle bone
- Bimalleolar Fracture – both ankle bones
- Trimalleolar Fracture – both the inside and outside ankle bone and back of the tibia (shin bone)
Complications Associated with Ankle Fractures:
- Non-union – if the bone doesn’t heal, it usually happens with a lateral malleolus fracture.
- Ligamentous instability – the ligament in the area of the fracture separates from the bone because it is torn.
- Traumatic degenerative arthritis – It has been reported that this complication occurs in somewhere between 20% & 40% of ankle fractures.
Fractures of the foot occur in motor vehicle accidents and slip & falls. In a motor vehicle collision, the patient will usually describe that their foot was either jammed or caught under the brake or gas pedal. In a slip & fall, the patient will usually report that they fell and landed directly on the foot (axial compression) or twisted the foot inward (inversion sprain). The following are the names of frequent foot fractures:
- Calcaneal fracture – fracture of the heel bone. This type of injury happens in head-on crashes.
- Avulsion fracture – usually occurs with a severe sprain. The mechanism of injury is similar to an avulsion fracture of the ankle.
- Talus fracture – fracture of the bone on the top of the foot.
- Fractures of the individual tarsal bones of the foot.
- Jones fracture – also known as a dancer’s fracture – it is a fracture of the fifth metatarsal
The most common complications of these foot fractures include:
- Non-union of the bone
- Avascular necrosis – death of the bone because the blood supply is disrupted
Shoulder Girdle Fractures
The shoulder bones can also break in car accidents. The shoulder girdle is made up of the clavicle (collar bone), humerus, and scapula (shoulder blade). The mechanism of injury in a car is usually associated with direct impact with the steering wheel, door, console or seat belt. The following are common fractures in the shoulder girdle:
- Scapula fracture (wing bone)– acromion, glenoid fossa
- Humerus fracture – anatomical neck, greater tuberosity, lesser tuberosity, surgical neck, proximal shaft
Dislocation of the shoulder is common because the shoulder has to move in so many directions and it is primarily stabilized by muscles.
Common complications associated with shoulder girdle fractures include:
- Blood vessel injury
- Nerve injury
- Loss of shoulder function
- Deformity of the bone
Fractures of the elbow usually occur in automobile accidents because the driver is holding onto the steering wheel or a passenger puts his/her arm out to brace themselves during the crash. In a slip & fall the injury is usually with the person putting out their arm to break the fall. The following are common elbow fractures:
- Distal humerus fracture
- Proximal ulna fracture
- Olecranon (elbow) fracture
- Radial head fracture
- Fracture of both the radius & ulnar
- Monteggia fracture
Common complications associated with fractures of the elbow include:
- Blood vessel injury
- Nerve damage
- Loss of motion or fusion of the joint
- Deformity of the joint
Fractures of the wrist have the same mechanism of injury as the elbow. Most of the time the person puts their arm out to brace themselves in the accident. The following are common names fractures associated with the wrist:
- Distal radius fracture
- Distal ulna fracture
- Colles’ fracture
- Smith’s fracture
- Ulna or radial styloid fractures
- Scaphoid/navicular fracture
- Fractures of the other wrist bones
The most common complications associated with fractures of the wrist include:
- Non-union of the bone. Many of the wrist bones are funny shaped and don’t have a great blood supply, which can lead to non-union.
- Deformity is more common with Colles and Smith’s fractures because the fracture itself has displacement of the bone.
- Avascular necrosis – death of the bone because of lack of blood supply to the bone. The scaphoid bone is the most common area for avascular necrosis following trauma.
If you or a loved one has experienced a fracture due to the negligence of another, be sure to contact our office today to see how we can help with your case.