PATHOPHYSIOLOGY OF CLOSED DISPLACEMENT SEGMENTAL FEMUR Most fractures result from a single application of significant force to otherwise normal

bone. Pathologic fractures result from application of mild or minimal force to a bone weakened by a disorder such as cancer, cysts, or osteoporosis. When Ca and vitamin D levels are adequate and bone tissue is healthy and the fracture edges are kept reasonably close to each other and with little or no relative motion, most fractures heal within weeks or months via remodeling. New tissue (callus) is produced within weeks, and bone reshapes at variable rates during the first weeks or months. Ultimately, optimal remodeling requires gradual resumption of normal motion and load-bearing stress. However, remodeling can be disrupted and refracture can occur if force is applied or the joint moves prematurely; thus, immobilization is usually needed. Serious complications are unusual. Arteries are injured occasionally in closed supracondylar fractures of the humerus and femur but rarely in other closed fractures. Compartment syndrome or nerve injury may occur. Fractures of long bones may release fat (and other marrow contents) that embolizes to the lungs and causes respiratory complications. Fractures that extend into joints usually disrupt articular cartilage; misaligned articular cartilage tends to scar, causing osteoarthritis and impairing joint motion. Occasionally, fractures do not heal (called nonunion); rarely, nonunion occurs even when treatment is expeditious and correct. If the vascular supply is injured by the initial injury (such as a scaphoid fracture), aseptic necrosis may ensue even if the fracture was properly immobilized. Pain is usually immediate. Swelling increases for several hours. Children may not exhibit significant soft-tissue swelling in the presence of a fracture. Pain and swelling usually begin to resolve after 12 to 24 h; worsening pain after this period suggests compartment syndrome. Other symptoms and signs may include bone tenderness, ecchymosis, decreased or abnormal motion, deformity, and crepitation.
Comminuted fractures include segmental fractures (2 separate breaks in a bone) Displacement is the degree to which the fractured ends are out of alignment with each other; it is described in millimeters or bone width percentage. Angulation is the angle of the distal fragment measured from the proximal fragment. Displacement and angulation may occur in the ventral-dorsal plane, lateral-medial plane, or both.

Reference: http://www.merckmanuals.com/professional/injuries_poisoning/fractures_dislocations_and_sprains/fr actures.html