trauma: complications of trauma Flashcards
name 4 early local complications of fractures
compartment syndrome, ischaemia, nerve compression, skin necrosis
name 5 early systemic complications of fractures
hypovolaemia, shock, ARDS, acute renal failure, systemic inflam response syndrome (SIRS), death
name 6 late local fracture complications
stiffness, loss of function, chronic pain syndrome, non-union, OA, DVT
name a late systemic fracture complication
PE
what is compartment syndrome
bleeding and inflam response causing rise in pressure in fascia compartment –> compressed venous system and secondary ischaemia
what are symptoms and signs of compartment syndrome
severe pain, loss of function, paraesthesia, severe pain out of clinical context, tensely swollen and tender, volkmann’s ischaemic contracture
what is volkmann’s ischaemic contracture
compartment syndrome where muscles necroes after being left too long
how do you treat compartment syndrome
remove tight clothing, fasciotomy
how do vascular injuries arise on trauma
penetrating/ blunt, vessels can be compressed and torn, partial tears of arterial intima can thrombose to an occlusion
what can digital limb ischaemia lead to
amputation
what can haemorrhage lead to
hypovolaemic shock
what vessel can be damaged in knee dislocations
popliteal artery
what vessel can be damaged in paediatric supracondylar fracture of the elbow
brachial artery
what vessel can be damaged in shoulder
axillary
fractures where can lead to life threatening haemorrhage
pelvis
how do you treat vascular injuries from fractures
shunt and repair (bypass r stent)
what are skin problems that can arise from fractures
laceration from bone, skin fragility, pressure –> blanching –> necrosis, shearing/ degloving
what are fracture blisters
from inflamm exudate causing lifting of epidermis
what are symptoms of non-union fracture
pain, oedema, movement at fracture site, bridging callus on imaging
what is delayed union
doesn’t heal in expected time, tibia and femoral shaft slow, can lead to infection
what is hypertrophic non-union
from excessive movement at fracture site
what is atrophic non-union
rigid fixation with fracture gap, lack of blood
what fractures can have a poor blood supply
scaphoid, distal clavicle, femur
when can DVT
after pelvic or major lower limb fracture to then being immobile
how do you prevent, identify and treat DVT after fracture
prophylactic LMWH to at risk patients, duplex scans and anticoag
what is fracture disease
stiffness and weakness from cast, resolves in time
where does AVN commonly occur
femoral neck, scaphoid, talus
how would you manage end stage AVN of common sites
hip - THR, scaphoid/ talus = arthrodesis
what fractures are at risk for OA
intra-articular and malunion
what is complex regional pain syndrome
heightened pain after injury, constant burning, throbbing, increased sensitivity, swelling and pain on movement
