Complications of Fractures Flashcards

1
Q

What are the acute complications of fractures?

A

Occur as part of the injury or within a few days/wks

Nerve Injury

Vascular Injury

Visceral injury

Compartment syndrome

Infection

Haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Discuss Nerve injury

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Discuss Vascular injury

A

More common with fractures around knee, elbow, humeral and femoral shafts

Presentation

  • paraesthesia
  • cold
  • pale
  • cyanosed
  • absent/weak pulses

Angiogram needed if suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are visceral injuries?

A

Example includes pneumothorax with rib fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is compartment syndrome?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are symptoms and management of compartment syndrome?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Discuss Infection

A

More common with an open fracture- must have prophylactic abx

Must excise all non-viable tissue and drain any infected tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Discuss Haemorrhage

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are late complications of fractures?

A
Infection
DVT/PE
Pressure sores
Delayed union
Non-union
Mal-union
Avascular necrosis
Joint instability
OA
Complex regional pain syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is delayed union?

A

Failure to reach union by 6 months post injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are risk factors for delayed union?

A
Poor blood supply
Infection
Poor apposition of bone ends
Presence of foreign body
Smoking
Poor nutritional status
Steroid therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the signs and management of delayed union?

A

Persisting fracture tenderness

Fracture line remains visible on XR

Must stop cause, immobilise bone in plaster and promote muscular exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is non-union?

A

Fracture will never unite without intervention

Diagnosed when not healed after double the expected time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the clinical features of non-union?

A

Pain diminishes as site gap becomes pseudoarthrosis (false joint forms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are investigations and management of non-union?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is avascular necrosis?

A

Osteonecrosis or bone infarction due to impaired blood supply

Pain and bone collapse

XR- increased bone density in necrotic segment

Treatment

  • re-manipulation
  • osteotomy (reshaping)
  • internal fixation
17
Q

What is joint instability?

A

Can be unstable or vulnerable to recurrent dislocation

18
Q

What is complex regional pain syndrome?

A

Pain in limb with sensory, motor and autonomic abnormalities

Normally unilateral

19
Q

What are the symptoms of complex regional pain syndrome?

A
Swelling
Pain out of proportion
Temp changes
Sweating
Goosebumps
Shiny skin
Pitting oedema
Limited movement

Refer to orthopaedics