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Musculoskeletal > Complications of fractures > Flashcards

Complications of fractures Flashcards

1
Q

Name 5 urgent local complications of fractures

A
  • Vascular injury
  • Local visceral injury
  • Compartment syndrome
  • Haemarthrosis
  • Nerve injury
  • Infection
  • Gas gangrene
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2
Q

Name 5 less urgent local complications of fractures

A
  • Pressure sores and blisters
  • Nerve entrapment
  • Heterotopic ossification: bone formation in soft tissue
  • Ligament injury
  • Tendon lesions
  • Joint stiffness
  • Regional pain syndrome
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3
Q

Name 5 late local complications of fractures

A
  • Malunion
  • Non-union
  • Avascular necrosis
  • Muscle contracture
  • Joint instability
  • Regional pain syndrome
  • Osteoarthritis
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4
Q

Name 2 emergency viscercal injuries following fracture

A
  • Pneumothorax: rib fractures
  • Ruptured bladder or urethra: pelvic fractures

These require emergency treatment prior to fracture treatment

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5
Q

Name the 3 commonest vascular injuries seen with fractures?

A
  • Anterior tibial artery: high tibial fracture
  • Brachial artery: supracondylar fracture
  • Femoral artery: femoral shaft fracture
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6
Q

List the hard signs of arterial injury

A
  • External bleeding
  • Rapidly expansile haematoma
  • Audible bruit
  • Palpable thrill
  • Signs of acute limb ischaemia
    • not corrected upon reduction or relignment of fracture
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7
Q

Outline the clinical features of acute limb ischaemia

A
  • Pain
  • Pallor
  • Paraesthesia
  • Paralysis
  • Pulselessness
  • Perishingly cold
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8
Q

What is the warm ischaemia duration prior to irreversible ischaemic damage?

A

Up to 6 hours

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9
Q

Name the vessel injury associated with first rib fracture

A

Subclavian artery

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10
Q

Name the vessel injury associated with shoulder dislocation

A

Axilliary artery

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11
Q

Name the vessel injury associated with humeral supracondylar fracture

A

Brachial artery

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12
Q

Name the vessel injury associated with elbow dislocation

A

Brachial artery

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13
Q

Name the vessel injury associated with pelvic fracture

A

Presacral and internal iliac vessels

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14
Q

Name the vessel injury associated with femoral supracondylar fracture

A

Femoral artery

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15
Q

Name the vessel injury associated with knee dislocation

A

Popliteal artery

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16
Q

Name the vessel injury associated with proximal tibial fracture

A

Popliteal artery or anterior tibial artery

17
Q

Name the nerve injury associated with shoulder dislocation

A

Axillary nerve

18
Q

Name the nerve injury associated with humeral shaft fracture

A

Radial nerve

19
Q

Name the nerve injury associated with humeral supracondylar fracture

A

Radial or median nerve

20
Q

Name the nerve injury associated with elbow medial condyle fracture

A

Ulnar nerve

21
Q

Name the nerve injury associated with elbow dislocation

A

Ulnar nerve

22
Q

Name the nerve injury associated with Montegia fracture

A

Posterior interosseous nerve

23
Q

Name the nerve injury associated with hip dislocation

A

Sciatic nerve

24
Q

Name the nerve injury associated with knee dislocation

A

Peroneal nerve

25
Q

What is the progonosis for nerve injuries in closed fractures?

A
  • 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
26
Q

What is the prognosis of nerve injuries in open fractures?

A
  • More likely to be complete lesion
  • Should be explored during wound debridement
  • Repaired at time of wound closure
27
Q

Define gas gangrene

A

A life-threatening clostridial infection featuring:

  • Muscle necrosis
  • Sepsis
  • Gas production
28
Q

Outline the pathophysiology of gas gangrene

A

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.

29
Q

How does gas gangrene present?

A

Symptoms appearwithin 24 hours of injury

  • Intense pain
  • Swelling
  • Foul-smelling discharge
  • Mild fever, tachycardia
  • Vesicles and bullae develop
  • Rapidly develop sepsis
30
Q

Name one important differential diagnosis for gas gangrene that must be ruled out, and why?

A

Anaerobic cellulitis: absence of myonecrosis

Failure to recognise the difference may lead to unecessary amputation for non-lethal cellulitis

31
Q

How is gas gangrene prevented?

A
  • Explore all deep, penetrating wounds in muscular tissue
  • Completely excise all dead tissue
  • Leave wound open
32
Q

How is gas gangrene treated?

A
  • Fluid replacement
  • IV antibiotics
  • Hyperbaric oxygen: limits spread of gangrene
  • Prompt decompression of wound and removal of all dead tissue
  • Amputation in advanced cases
33
Q

Name 4 causes of delayed union of fractures

A
  • Severe soft-tissue damage
  • Poor blood supply
  • Periosteal stripping: avoid cause during internal fixation
  • Infection
  • Implant failure: loosen or break apart
  • Patient factors
34
Q

What is complex regional pain syndrome?

A

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

35
Q

List 3 symptoms of complex regional pain syndrome

A
  • 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
36
Q

What is the management of complex regional pain syndrome?

A
  • Analgesics or neuropathic medication
  • Education
  • Physical rehabilitation
  • Psychological needs

Musculoskeletal (17 decks)

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