Complications of fractures

53 Complications of fractures





Questions



image What are potential complications of a fracture?

image What simple tests can be used for suspected compartment syndrome?

image What are the symptoms of fat embolus and when does it occur?

The complications of fractures are best considered by the time at which they occur: early general (hypovolaemic shock, acute respiratory distress syndrome (ARDS), fat embolism, DVT and pulmonary embolism, chest infection), early local (compartment syndrome, neurovascular damage, bone and joint infection (Ch. 66), blisters and plaster sores, avascular necrosis), late instability (stiffness; osteoarthritis; chronic osteomyelitis; mal-, non-, delayed union; Volkmann’s ischaemic contractures).




Compartment syndrome


Compartment syndrome is a surgical emergency. The circulation and function of tissues within a fascial compartment become compromised by increased swelling within that compartment. It can occur within any muscular compartment following an open or closed fracture, crush injury or reperfusion injury. The most common site is the calf (Fig. 3.53.1) and the most common cause is an overtight backslab/plaster cast.


image

Fig. 3.53.1 Compartment syndrome. (A) Compartments of the leg; (B) fracture causes damage and swelling, increasing pressure and compression of nerves and blood vessels; (C) a fasciotomy: incisions are made in the leg and left open, which relieves pressure.



Pathology


Increasing swelling leads to an increase in the intracompartmental pressure; this eventually becomes higher than the venous pressure, thus preventing blood leaving the compartment. Further rise in pressure prevents the entry of arterial blood, causing rapid ischaemia with muscle and nerve necrosis. Subsequent rhabdomyolysis may cause acute renal failure and death.

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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Complications of fractures

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