Fracture complications Flashcards
In the arm and leg which fractures are most commonly associated with compartment syndrome?
Supracondylar fractures in the arm and tibial fractures in the leg
Describe the presentation of compartment syndrome
Pain, especially on movement (even passive)
Parasthesiae
Pallor may be present
Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise
Paralysis of the muscle group may occur
How is a diagnosis of compartment syndrome made?
Diagnosis
Is made by measurement of intracompartmental pressure measurements. Pressures in excess of 20mmHg are abnormal and >40mmHg is diagnostic
Compartment syndrome will typically not show any pathology on an x-ra
How is compartment syndrome treated
Treatment
This is essentially prompt and extensive fasciotomies
In the lower limb the deep muscles may be inadequately decompressed by the inexperienced operator when smaller incisions are performed
Myoglobinuria may occur following fasciotomy and result in renal failure and for this reason these patients require aggressive IV fluids
Where muscle groups are frankly necrotic at fasciotomy they should be debrided and amputation may have to be considered
Death of muscle groups may occur within 4-6 hours
What is the triad of symptoms associated with a fat embolism?
Resp - early, persistent tachycardia. Tachypnoea, dyspnoea, hypoxia within 72 hours of injury and pyrexia.
Dermatological - red/brown impalpable petechial rash
CNS - confusion and agitation, retinal haemorrhages and intra arterial fat globules on fundoscopy.
How would fat embolism typically present?
tachy, low grade pyrexia with abnormal oxygen saturation and usually between 12 and 72 hours
Main reasons for revision of total hip replacement?
Most common - aseptic loosening
Pain
dislocation
Infection
Complication of total hip replacement
Venous thromboembolism
Intraoperative fracture
Nerve injury
