complication of fractures

I. general complications:

Blood loss. Shock. diffuse coagulopathy . respiratory dysfunction. metabolic response.

tetanus. gas gangrene. fat embolism.

Crush syndrome. (if bulk muscle is crushed it is reflected on the kidney function ,end with renal failure.) Venous thrombosis &pulmonary embolism. In veins of the calf and less in the thigh.

II Local complications

A:early . ( bone ,soft tissue). B:late. (bone ,soft tissue,joint).

Early  complications bone

Infection particularly in compound fracture.

Vascular injury.

Brachial artery. Popliteal artery.

Nerve injury.

(neuropraxia, neurotemesis, axonotemesis).

nerve
Injury
Sciatic
Hip dislocation
Posterior interosseous
Monteggia fracture dislocation
Ulnar
Medial epicondyle medial
Radial or median
Supracondylar humerus
Radial
Fracture humerus shaft
Axillary
Shoulder dislocation

Visceral injury.

diaphragm (in fracture pelvis).

Compartment syndrome.

Fracture of the arm or the leg can give rise to severe ischaemia even if there is no damage to a major vessel. this lead to reduce in the capillary flow.

Bleeding,edema, inflammation

Increase the interistial pressure Within osteofascial Compartment > 40mm
Reduce in capillary flow
Muscle ischaemia
Further edema
Greater pressure &greater ischaemia



After 12 hours or less necrosis of the nerve,which is capable for regeneration.But muscle once infract can never recovers and is replaced by inelastic fibrous tissue(VOLKMANNS’ ischaemia contractures)

Clinical features

Five Ps. Pain with sever swelling . Parasthesia. Pallor. Paralysis. Pulse less.

Treatment

Removal cast bandage. Fasciotomy >40 mm Hg. <40 mmHg close observation. The wound should be left open and inspected 5 days late to be suture or skin graft.

Fracture blisters occurred by edema. Plaster sores. Torn muscle fibers.

Haemarthrosis. Gas gangrene with clostridium M.O. in a dirty wound



Late complicationsbone

avascular necrosis: Due to ischaemia after injury.as fracture neck femur.

Delayed union:


1.inadequate blood supply. 2.infection. 3.incorrect splint age. 4.intact fellow bone (as in fracture tibia and fibula).

Non union:

1.too large gap. 2.Soft tissue interposition. 3.Intra articular fractures.

Mal union: When the fragments join in an unsatisfactory position.

Growth disturbance damage to the physis may lead to abnormal or arrested growth.

Late soft tissue complications

Myositis ossificans (heterotopic ossification in muscle as after elbow injury ). Bed sores


Tendinitis: (tibilalis posterior in ankle fracture). Tendon rupture: (extensor pollicis longus in colles).

Nerve compression: as in radial palsy followed faulty use of crutches. Nerve entrapment: ( median nerve following injuries around wrist).

Volkmann's’ contracture

Late jointscomplication

Sudecks’ atrophy.(painful osteoporosis of the hand ,reflex sympathetic dystrophy ).

Osteoarthritis. (fracture involving a joint may severely damage the articular cartilage).

Instability . (muscle weakness, gun shot with bone loss, recurrent dislocation) Joint stiffness. due to oedema and fibrosis of the capsule.

Osteogesis imperfecta.Pagets’ disease.Chronic infection.Solitary bone cyst.

Aneurysmal bone cyst. Osteosarcoma. Ewing's sarcoma. Metastatic tumors

Clinical features of pathological

Fracture develop spontaneously or after trivial injury.

Examinations:

general &Local.

Investigations:

x-r, blood, urine, scanning, biopsy.

Treatment :

Underlying pathology , and fixation with bone cement and internal fixation.