T&O - Fracture Complications Flashcards
General complications: tissue damage
- Haemorrhage and shock
- Infection
- Muscle damage → rhabdomyolysis
General complications: anaesthesia
- Anaphylaxis
- Damage to teeth
- Aspiration
General complications: prolonged bed rest
- Chest infection
- UTI
- Pressure sores/muscle washing
- DVT/PE
Specific complications: immediate
- Neurovascular damage
- Visceral damage
Specific complications: early
- Compartment syndrome
- Infection (worse if associated with metalwork)
- Fat embolism: ARDS
Specific complications: late
- Problems with union
- Avascular Necrosis
- Growth disturbance
- Post traumatic osteoarthritis
- Complex regional pain syndromes
- Myosotis ossificans
Neurological complications of fractures
Severance is rare, stretching over bone edge is more common
- Neuropraxia: temporary interruption of conduction without loss of atonal continuity
- Axonotmesis: disruption of nerve axon
- Distal wallerian degeneration - regeneration occurs and recovery is possible
- Neurotmesis: disruption of entire nerve fibre
Late complications - Compartment syndrome: pathophysiology
- Osteofacial membranes divide limbs into separate compartments of muscles.
- Oedema following fracture leading to increased compartment pressure so less venous drainage so further increase compartment pressure
- If compartment pressure > capillary pressure then ischaemia
- Muscle infarction as result of ischaemia leads to Rhabdomyolysis and ATN (acute tubular necrosis) + Fibrosis
- Volkman’s ischaemic contracture
Late complications - Compartment syndrome: presentation
- Pain out of proportion to clinical findings
- Pain on passive muscle stretching
- Warm, erythematous, swollen limb
- IncreasedCRT and weak/absent peripheral pulses
Late complications - Compartment syndrome: Rx
- Elevate limb
- Remove all bandages and split/remove cast
- Fasciotomy
Late complications - Non union: definition and types
Nonunion: if bone has failed to unite after several months, unlikely to heal without intervention
-
Hypertrophic non-union:
- Elephant feet
- Dense and sclerotic
- Can get formation of false joint
- Atrophic non-union: Probably due to inadequate blood supply
Late complications - What is malunion?
Fracture healed in imperfect position
- Shortened
- Angulated
- Rotated
Late complications - AVN: common sites?
Common sites are
- Femoral head
- Scaphoid
- Talus
Late complications: what is Sudek’s atrophy?
collection of symptoms
- Persistent pain, swelling, redness, sweating:
- thought to be due to abnormal sympathetic response to injury
Late complications: what is myossitis ossificans?
- calcification forms in soft tissues after injury/surgery - cause painful and restricted movement.
Outline the Salter-Harris classification
