Complications of Fractures Flashcards
What are the acute complications of fractures?
Occur as part of the injury or within a few days/wks
Nerve Injury
Vascular Injury
Visceral injury
Compartment syndrome
Infection
Haemorrhage
Discuss Nerve injury
Common with humeral, elbow and knee fractures
Must check neurovascular status
In closed injury-nerve often not severed, will recover in 4 months
In open fractures- need to be opened and repaired
Discuss Vascular injury
More common with fractures around knee, elbow, humeral and femoral shafts
Presentation
- paraesthesia
- cold
- pale
- cyanosed
- absent/weak pulses
Angiogram needed if suspected
What are visceral injuries?
Example includes pneumothorax with rib fracture
What is compartment syndrome?
Bleeding, oedema, inflammation can cause increased pressure in oesteofacial compartment
Can lead to muscle ischaemia and nerve necrosis
Long term damage occurs after 6 hours
Forearm and lower leg flexor compartments are most commonly affected
Increased pressure causes venous collapse and increased capillary bed pressure leading to fluid leaking out causing increased pressure
What are symptoms and management of compartment syndrome?
Symptoms
- worst ever ‘burning’ pain
- not relieved by opiates
- pulse present
- warm/red limb
Immediate decompression needed
If diagnosis in doubt- compartmental pressure catheters are used
->30mmHg above DBP then immediate decompression needed
Discuss Infection
More common with an open fracture- must have prophylactic abx
Must excise all non-viable tissue and drain any infected tissue
Discuss Haemorrhage
Hemarthrosis- blood accumulation in joint- becomes swollen and patient resists movement
-must aspirate
Gas gangrene
-infection in dirty wound (clostridium welchii) with dead muscle that has not been closed with adequate debridement
Fracture blisters
Plaster sores and pressure sores
What are late complications of fractures?
Infection DVT/PE Pressure sores Delayed union Non-union Mal-union Avascular necrosis Joint instability OA Complex regional pain syndrome
What is delayed union?
Failure to reach union by 6 months post injury
What are risk factors for delayed union?
Poor blood supply Infection Poor apposition of bone ends Presence of foreign body Smoking Poor nutritional status Steroid therapy
What are the signs and management of delayed union?
Persisting fracture tenderness
Fracture line remains visible on XR
Must stop cause, immobilise bone in plaster and promote muscular exercise
What is non-union?
Fracture will never unite without intervention
Diagnosed when not healed after double the expected time
What are the clinical features of non-union?
Pain diminishes as site gap becomes pseudoarthrosis (false joint forms)
What are investigations and management of non-union?
XR- fracture is visible
- hypertrophic- fracture ends are enlarged
- atrophic- fracture ends tapered
Treatment is either conservative with splinting or surgical with rigid fixation and bone graft
