Table Of Contents
Complications of Fractures
Summary of complications of fractures
| Onset | Examples |
|---|---|
| Urgent early complications | Visceral injury, vascular injury, nerve injury, compartment syndrome, hemarthrosis, infection, gas gangrene |
| Less urgent early complications | Fracture blister, pressure sore, heterotrophic ossiifcation, ligament injury, tendon injury, nerve compression, joint stiffness, complex regional pain syndrome (algodystrophy) |
| Late complications | Delayed union, non-union, malunion, avascular necrosis, growth disturbance, bed sores, muscle contracture, joint instability, osteoarthritis |
Some Selected Complications of Fractures
- Visceral injury
- Rib fracture: pneumothorax
- Pelvic fracture: ruptured bladder or urethra
- Vascular injury
- Order an angiogram or duplex if suspected
- Sx: paresthesia, numb toes or fingers, cold and pale limb, slight cyanosis, weak peripheral pulse
- High-risk fractures for vascular injury
- Knee dislocation: Popliteal
- Elbow dislocation: Brachial
- Femoral shaft fracture: femoral
- Humeral shaft fracture: Brachial
- Supracondylar humeral fracture: Brachial
- First rib fracture: subclavian
- Shoulder dislocation: axillary
- Pelvic fracutre: presacral, internal iliac
- Proximal tibial: popliteal or its branches
- Nerve injury
- Closed nerve injury: seldom severed, await spontaneous recovery (90% of cases in 4 months)
- Open nerve injury: Completely severed. Explore nerve at debridement and repair at debridement or wound closure
- Acute nerve compression: common in fractures or dislocations of the wrist
- High-risk fractures for nerve injury
- Shoulder dislocation: axillary
- Humeral shaft fracture: Radial
- Humeral supracondylar fracture: Radial or median
- Elbow medial condyle: Ulnar
- Monteggia fracture-dislocation: Posterior interosseus
- Hip dislocation: Sciatic
- Knee dislocation: Peroneal
- Indications for early exploration in nerve injury
- Nerve injury associated with open fracture
- Nerve injury with fractures that need internal fixation
- Presence of concomitant vascular injury
- Nerve damage diagnosed after manipulating the fracture
- Compartment syndrome
- Pain: severe pain, ‘ bursting’ sensation
- Paresthesia
- Pallor
- Paralysis
- Pulsenessness: pulse may still be present as occlusion is at the capillary level
- High-risk injuries and precipitating factors for compartment syndrome
- Fractures
- Elbow
- Forearm
- Proximal tibia
- Multiple fractures of the hand or foot
- Injuries
- Crush injuries
- Circumferential burns
- Precipitating factors
- Internal fixation
- Infection
- Fractures
- Hemarthrosis
- Fractures involving joint
- Signs and symptoms: swollen joint, tense, patient resists moving it
- Aspirate blood before dealing with the fracture
- Infection
- Open fractures carry a high risk
- Closed fractures rarely get infected unless ORIF is performed
- Gas gangrene
- Culprit: Clostridium welchii AKA Clostridium pergringens
- Signs and symptoms: intense pain and swelling around the wound, brownish discharge, gas formation not marked, little or no pyrexia, increased heart rate, characteristic smell, toxemia, coma, death
- Fracture blister
- Tense clear-fluid filled vesicles (serous blisters) or blood-stained vesicles (hemorrhagic blisters)
- Reflects significant swelling and shearing of the dermal-epidermal junction. Commonly occur in areas with minimal soft-tissue padding.
- They should not be deroofed. Postpone internal fixation (temporary external fixation) until the blister re-epithelializes
- Plaster and pressure sores
- Padd bony points
- Mould the wet plaster so pressure is distributed fo soft tissue around bony points
- Signs and symptoms: localised burning pain
