T&O - Fracture Complications

Question 1

General complications: tissue damage

Answer 1

-Haemorrhage and shock -Infection -Muscle damage → rhabdomyolysis

Question 2

General complications: anaesthesia

Answer 2

Anaphylaxis Damage to teeth Aspiration

Question 3

General complications: prolonged bed rest

Answer 3

-chest infection, UTI -Pressure sores/muscle washing -DVT/PE

Question 4

Specific complications: immediate

Answer 4

-Neurovascular damage -visceral damage

Question 5

Specific complications: early

Answer 5

-Compartment syndrome -infection (worse if associated with metalwork) -Fat embolism: ARDS

Question 6

Specific complications: late

Answer 6

-Problems with union -AVN -Growth disturbance -post traumatic osteoarthritis -complex regional pain syndromes -myosotis ossificans

Question 7

Neurological complications

Answer 7

-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

Question 8

Late complications - Compartment syndrome: pathophysiology

Answer 8

-Osteofacial membranes divide limbs into separate compartments of muscles. -Oedema following # → ↑ compartment pressure → ↓ venous drainage → ↑ compartment pressure -If compartment pressure > capillary pressure → ischaemia  Muscle infarction → Rhabdomyolysis and ATN (acute tubular necrosis) + Fibrosis → Volkman’s ischaemic contracture

Question 9

Late complications - Compartment syndrome: presentation

Answer 9

-Pain > clinical findings -Pain on passive muscle stretching -Warm, erythematous, swollen limb -↑ CRT and weak/absent peripheral pulses

Question 10

Late complications - Compartment syndrome: Rx

Answer 10

-Elevate limb -remove all bandages and split/remove cast -fasciotomy

Question 11

Late complications - Non union: definition and types

Answer 11

◦ Nonunion: if bone has failed to unite after several months, unlikely to heal without intervention ‣ Hypertrophic: elephant feet, dense and sclerotic, can get formation of false joint ‣ Atrophic non union: probably due to inadequate blood supply

Question 12

Late complications - What is malunion?

Answer 12

fracture healed in imperfect position (shortened, angulated, rotated)

Question 13

Late complications - AVN: common sites?

Answer 13

common sites are femoral head, scaphoid, talus

Question 14

Late complications: what is Sudek’s atrophy?

Answer 14

collection of symptoms

‣ Persistent pain, swelling, redness, sweating: thought

to be due to abnormal sympathetic response to

injury

Question 15

Late complications: what is myossitis ossificans?

Answer 15

calcification forms in soft tissues after injury/surgery - cause painful and restricted movement.

Question 16

Late complications: what can cause growth disturbance?

Answer 16

can occur if damage is through growth pate/physis. Use Salter-Harris classification (type I do well, Type IV do badly)

Question 17

Outline the Salter-Harris classification

Answer 17