Complications of fractures

I. general complications: 5/20/2018 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 5/20/2018 II Local complications A:early . ( bone ,soft tissue). B:late. (bone ,soft tissue,joint).

Early complications bone 5/20/2018 Early complications bone Infection particularly in compound fracture.

5/20/2018 Soft tissue complications

Vascular injury. Brachial artery. Popliteal artery.

Nerve injury. (neuropraxia, axonotemesis, neurotemesis).

Posterior interosseous 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).

5/20/2018 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.

Increase the interistial pressure Bleeding,edema, inflammation 5/20/2018 Increase the interistial pressure Within osteofascial Compartment > 40mm Greater pressure &greater ischaemia Further edema Reduce in capillary flow Muscle ischaemia

(VOLKMANNS’ ischaemia contractures) 5/20/2018 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. 5/20/2018 Clinical features Five Ps. Pain with sever swelling . Parasthesia. Pallor. Paralysis. Pulse less.

Treatment Removal cast bandage. Fasciotomy >40 mm Hg. 5/20/2018 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 complications bone 5/20/2018 Late complications bone avascular necrosis: Due to ischaemia after injury.as fracture neck femur.

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. 5/20/2018 Non union: 1.too large gap. 2.Soft tissue interposition. 3.Intra articular fractures(scaphoid).

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 5/20/2018 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 joints complication 5/20/2018 Late joints complication 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.

Pathological fracture

Osteogesis imperfecta. Pagets’ disease. Chronic infection. 5/20/2018 Osteogesis imperfecta. Pagets’ disease. Chronic infection. Solitary bone cyst.

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

Clinical features of pathological 5/20/2018 Clinical features of pathological Fracture develop spontaneously or after trivial injury.

Examinations: general &Local.

Investigations: x-ray, blood, urine, scanning, biopsy.

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