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Fractures > Complications of Fractures > Flashcards

Complications of Fractures Flashcards

1
Q

List the common complications of fractures.

A
  • NEUROVASCULAR DAMAGE
  • BLEEDING +/- SHOCK
  • THROMBOEMBOLISM/FAT EMBOLISM
  • COMPARTMENT SYNDROME
  • INFECTION
  • DELAYED UNION
  • NON UNION
  • MAL UNION
  • AVASCULAR NECROSIS
  • LOSS OF MOVEMENT/STIFFNESS/ POST-TRAUMATIC ARTHRITIS
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2
Q

List the early complications of fractures.

A
  • Bleeding (+/- hypovolaemic shock)
  • Fat embolism
  • Compartment syndrome
  • Neurovascular damage
  • Infection
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3
Q

List the late complications of fractures.

A
  • Delayed/Mal/Non-union
  • Stiffness
  • Avascular necrosis
  • Tendon Rupture
  • Pressure sores
  • UTI/Chest sepsis
  • PE
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4
Q

Provide some examples of fractures and the nerves/blood vessels at risk.

A
  • Humeral neck: axillary nerve
  • Humeral shaft: radial nerve
  • Elbow: brachial artery & all adjacent nerves ( e.g. anterior interosseous, ulnar)
  • Hip: sciatic nerve
  • Knee: all structures of popliteal fossa including vessels
  • Proximal fibula: common fibular (aka peroneal) nerve
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5
Q

How does one assess blood flow distal to fracture injury?

A

•Ensure pulses are palpable distal to the any fracture site
•If not palpable, use a Doppler probe to identify if
present/absent

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6
Q

What two fractures may lead to life-threatening internal bleeding (hypovolaemic shock)?

A
  • Pelvic and femoral fractures.
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7
Q

How is shock treated in these cases?

A 
•IV fluids to Increase 
intravascular volume with 
•+ blood transfusion if severe
•+ coagulation factors if 
massive transfusion
•+ surgery  if required (e.g. 
pelvic external fixator)
•+/- radiological intervention in 
pelvis
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8
Q

Outline some VTE risk factors in fracture patients.

A 
•Immobility (e.g. cast)
•Pelvic/lower limb fracture +/-
Surgery
•Venous stasis
•Hypercoagulable state
•Smoking
•Dehydration
•Previous DVT
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9
Q

How is DVT diagnosed?

A
  • Doppler ultrasound of veins (i.e. USS with doppler AKA duplex)
  • Venogram used in some units
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10
Q

How is PE diagnosed?

A

• CTPA most common
• V:Q scan may be considered if
no concurrent lung disease

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11
Q

Outline VTE prevention.

A

Mechanical:

• TED stockings, encourage of mobility

Chemical:

• Low molecular weight
heparin e.g. enoxaparin

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12
Q

Outline VTE treatment.

A

•Usually LMWH (e.g. enoxaparin) at
therapeutic dose.

•May need longer term
antithrombotic medication e.g. warfarin depending on cause & circumstances (discuss with haematology)

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13
Q

Which fractures is fat embolism associated with?

A

Long bone fractures.

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14
Q

Discuss the pathophysiology of fat embolism.

A

Fat globules from marrow dissolve into bloodstream and travel to occlude small vessels lungs/brain/kidney

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15
Q

What are the signs of fat embolism?

A
  • Hypoxia
  • Tachycardia
  • Tachypnoea
  • Pyrexia
  • Dyspnoea
  • Chest pain
  • Petechial rash
  • General agitation
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16
Q

How is fat embolism prevented?

A 
•High flow oxygen
•Splintage
•Maintenance of fluid status
•Urgent stabilisation of long 
bone fracture
17
Q

How is fat embolism treated?

A

ANAESTHETIST:

  • Respiratory support
  • Early HDU/ICU involvement
  • High flow oxygen
  • Fluid resuscitation
  • Corticosteroid
  • Vasopressors
18
Q

Define compartment syndrome.

A

Haematoma and oedema from fracture raises the pressure within the osteofascialcompartment which results in decreased perfusion of tissues and muscle ischaemia (ischaemia of capillaries; no ischaemia of macro vessels)

19
Q

What are the signs and symptoms of compartment syndrome?

A
  • PAIN PAIN PAIN

- PAIN on passive stretch of affected muscle group

20
Q

How is suspected compartment syndrome managed?

A

•Analgesia
•High flow Oxygen
•Split cast (may be external pressure rather than internal)
Contact senior ASAP!
•Emergency surgery for fasciotomies.
•Failure to recognise & treat surgically promptly can result in amputation.

21
Q

What is the normal healing time for upper and lower limb fractures?

A

Upper limb: 6 weeks

Lower limb: 12 weeks

22
Q

What factors may slow the union of a fracture?

A 
Smoking
NSAIDs: do not give NSAIDS for fracture analgesia 
Diabetes
Steroids
Poor nutrition
23
Q

What is non-union of a fracture?

A
  • Failure to unite at 3months
  • Poor stability at fracture site
  • Poor soft tissues
24
Q

What is malunion of a fracture?

A
  • When the fragments unite in an unsatisfactory position (e.g. with overlap or angulation)
  • Decreased range of movement
  • Loss of function
25
Q

What fractures is avascular necrosis most commonly seen in?

A 
• Scaphoid fracture
• Intracapsular hip fracture
• Talar neck  fracture
• Comminuted humeral neck 
fractures (4-part)
26
Q

What is post-traumatic arthritis?

A
  • Patients with an intra-articular fracture

* Residual step in joint can lead to premature wear of articular cartilage and secondary osteoarthritis

Fractures (14 decks)

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