Complications of fractures Flashcards
Name 5 urgent local complications of fractures
- Vascular injury
- Local visceral injury
- Compartment syndrome
- Haemarthrosis
- Nerve injury
- Infection
- Gas gangrene
Name 5 less urgent local complications of fractures
- Pressure sores and blisters
- Nerve entrapment
- Heterotopic ossification: bone formation in soft tissue
- Ligament injury
- Tendon lesions
- Joint stiffness
- Regional pain syndrome
Name 5 late local complications of fractures
- Malunion
- Non-union
- Avascular necrosis
- Muscle contracture
- Joint instability
- Regional pain syndrome
- Osteoarthritis
Name 2 emergency viscercal injuries following fracture
- Pneumothorax: rib fractures
- Ruptured bladder or urethra: pelvic fractures
These require emergency treatment prior to fracture treatment
Name the 3 commonest vascular injuries seen with fractures?
- Anterior tibial artery: high tibial fracture
- Brachial artery: supracondylar fracture
- Femoral artery: femoral shaft fracture
List the hard signs of arterial injury
- External bleeding
- Rapidly expansile haematoma
- Audible bruit
- Palpable thrill
- Signs of acute limb ischaemia
- not corrected upon reduction or relignment of fracture
Outline the clinical features of acute limb ischaemia
- Pain
- Pallor
- Paraesthesia
- Paralysis
- Pulselessness
- Perishingly cold
What is the warm ischaemia duration prior to irreversible ischaemic damage?
Up to 6 hours
Name the vessel injury associated with first rib fracture
Subclavian artery
Name the vessel injury associated with shoulder dislocation
Axilliary artery
Name the vessel injury associated with humeral supracondylar fracture
Brachial artery
Name the vessel injury associated with elbow dislocation
Brachial artery
Name the vessel injury associated with pelvic fracture
Presacral and internal iliac vessels
Name the vessel injury associated with femoral supracondylar fracture
Femoral artery
Name the vessel injury associated with knee dislocation
Popliteal artery
Name the vessel injury associated with proximal tibial fracture
Popliteal artery or anterior tibial artery
Name the nerve injury associated with shoulder dislocation
Axillary nerve
Name the nerve injury associated with humeral shaft fracture
Radial nerve
Name the nerve injury associated with humeral supracondylar fracture
Radial or median nerve
Name the nerve injury associated with elbow medial condyle fracture
Ulnar nerve
Name the nerve injury associated with elbow dislocation
Ulnar nerve
Name the nerve injury associated with Montegia fracture
Posterior interosseous nerve
Name the nerve injury associated with hip dislocation
Sciatic nerve
Name the nerve injury associated with knee dislocation
Peroneal nerve
What is the progonosis for nerve injuries in closed fractures?
- Spontaneous recovery: 90% within 4 months
- Nerve is rarely severed
- If nerve has not recovered in the expected time, and conduction studies fail to show evidence of recovery -> exploration
What is the prognosis of nerve injuries in open fractures?
- More likely to be complete lesion
- Should be explored during wound debridement
- Repaired at time of wound closure
Define gas gangrene
A life-threatening clostridial infection featuring:
- Muscle necrosis
- Sepsis
- Gas production
Outline the pathophysiology of gas gangrene
Clostridium perfringens enters open fracturs usually after contact with soil. Since it is an anaerobic organism, it requires a sufficiently devitalised tissue environment to cause infection.
Toxins are released which lead to coagulation, thrombosis, and haemolysis of RBCs. They also cause cardiac depression and vasodilatation.
How does gas gangrene present?
Symptoms appearwithin 24 hours of injury
- Intense pain
- Swelling
- Foul-smelling discharge
- Mild fever, tachycardia
- Vesicles and bullae develop
- Rapidly develop sepsis
Name one important differential diagnosis for gas gangrene that must be ruled out, and why?
Anaerobic cellulitis: absence of myonecrosis
Failure to recognise the difference may lead to unecessary amputation for non-lethal cellulitis
How is gas gangrene prevented?
- Explore all deep, penetrating wounds in muscular tissue
- Completely excise all dead tissue
- Leave wound open
How is gas gangrene treated?
- Fluid replacement
- IV antibiotics
- Hyperbaric oxygen: limits spread of gangrene
- Prompt decompression of wound and removal of all dead tissue
- Amputation in advanced cases
Name 4 causes of delayed union of fractures
- Severe soft-tissue damage
- Poor blood supply
- Periosteal stripping: avoid cause during internal fixation
- Infection
- Implant failure: loosen or break apart
- Patient factors
What is complex regional pain syndrome?
Chronic debilitating continuous burning pain that affects the limbs.
Usually associated with sensory, motor, autonomic, skin, and bone abnormalities.
Type I: absence of identifiable nerve injury
Type II: presence of damage to a major nerve
List 3 symptoms of complex regional pain syndrome
- Pain: typically burning and out of proportion
- Not confined to a nerve or dermatome
- Muscle weakness and disuse atrophy
- Sensitivity to touch
- Allodynia: pain from non-painful stimulus
- Hyperalgesia: increased pain sensitisation
- Swelling
- Spontaneous temperature changes in limb
- Spontaneous sweating
- Pilomotor: goosebumps
What is the management of complex regional pain syndrome?
- Analgesics or neuropathic medication
- Education
- Physical rehabilitation
- Psychological needs
