Complications of fractures Flashcards
What are the early local complications of fractures?
Vascular injury and distal necrosis
Skin necrosis
Nerve injury
Compartment syndrome
What is a neurapraxia?
Temporary conduction block/demyelination
Within how long should neurapraxia resolve?
28 days
What is axonotmesis?
Axon dies distally from point of injury/wallerian degeneration
Does axonotmesis recover?
Yes, slowly
What is neurotmesis?
Complete transection of a nerve
How common is neurotmesis with fracture or dislocation?
Rare
Does neurotmesis recover?
Not without surgery
When should a nerve injury be explored?
Open fracture
Neuralgic pain
Penetrating injury
Why is neuralgic pain an indication for surgical exploration of a fracture?
Indicates ongoing compression
What can be done if no nerve function returning?
Nerve conduction studies
Grafting
Tendon transfers
What are the early systemic complications of a fracture?
Fat embolism Hypovolaemia Acute respiratory distress syndrome Multi-organ dysfunction syndrome Systemic inflammatory response syndrome
What are the late local complications of a fracture?
Loss of function DVT Avascular necrosis Osteomyelitis Chronic regional pain syndrome Post-traumatic arthritis Non-union (atrophic, hypertrophic) Malunion Volkmann's ischaemic contracture
What are the symptoms of malunion?
Pain
Stiffness
Deformity
Loss of function
Which fractures require x-rays to confirm healing?
Diaphyseal fractures of major long bones
What are the signs of fracture healing?
Pain improved
No movement at site
No swelling or oedema
No tenderness
What causes atrophic non-union?
Poor blood supply to the fracture site Fracture gap too big Systemic disease Smoking Steroids, NSAIDs, biphosphonates
What causes hypertrophic non-union?
Too much movement at the fracture site
Does infection cause atrophic or hypertrophic non-union?
Both
What causes volkmann’s ischaemic contracture?
Obstruction of brachial artery in forearm
What is complex regional pain syndrome?
Exaggerated pain response due to injury
What are the symptoms of complex regional pain syndrome?
Causalgia
Allodynia
Swelling
Skin changes
How is complex regional pain syndrome treated?
Referral to pain specialist
What is a late systemic complication of a fracture?
Pulmonary embolus
