Complications of fractures

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* 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.

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* Vascular injury.
Brachial artery. Popliteal artery.

* Nerve injury.

(neuropraxia, axonotemesis, neurotemesis).

* nerve

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


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* 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)


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* 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.


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* 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.



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* Delayed union:

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

* Non union:

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


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

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


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* 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

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* 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.

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

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* 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-ray, blood, urine, scanning, biopsy.


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* Treatment :

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