Incomplete fractures associated with penetrating trauma: etiology, appearance, and natural history

Patient charts and radiographs of 12 patients noted to have an incomplete fracture due to a penetrating injury were reviewed to evaluate the natural history of these fractures. One cortical chip fracture was due to a stab wound; the remainder were due to low-energy handguns. Morphologically, two patterns existed: drill hole fractures through the central metaphyseal region of long tubular bones, and divot fractures of the margins of long bone metaphyses and flat bones. Drill hole fractures and divot fractures complicated by fracture line extension required a weight bearing cast or functional brace while healing. The chip fracture and uncomplicated divot fractures were managed symptomatically. Chip, drill hole, and divot fractures followed a benign course and healed by formation of cortical bone along the defect rim.