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LOWER LIMB FRACTURE Complications Professor Jegan Krishnan Flinders University Adelaide, South Australia Specialists Without Borders Seminar in Surgery Rwanda, September 2010
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www.specialistswithoutborders.org Learning Objectives Identifying the common lower limb fracture complications Early assessment and management Prevention of complications
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www.specialistswithoutborders.org Infection Infection at fracture prevented by early and maticulouss debridement Early appropriate antibiotics Fracture stabilisation Soft tissue coverage
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www.specialistswithoutborders.org Compartment Syndrome Most common fracture complication missed Early assessment Clinical features Compartment Pressure Measurements Early Fasciotomy
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www.specialistswithoutborders.org Vascular Injury Early recognition Early Investigation Vascular Surgery Consultation Reanastomosis
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www.specialistswithoutborders.org Vascular Injury
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www.specialistswithoutborders.org Neurological Injury Early assessment both pre-reduction and post reduction Majority of injuries are neuropraxia When to explore is a tricky decision
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www.specialistswithoutborders.org Neuropraxia Early recognition Determine level of injury Observe recovery rate Nerve conduction test and EMG Explore if recovery rate not progressing as expected
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www.specialistswithoutborders.org Non Union Definition Types – Hypertrophic – Atrophic Management – Stabilisation – Bone Grafting
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www.specialistswithoutborders.org Malunion Definition Management
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www.specialistswithoutborders.org SUMMARY Best management is prevention Early suspicion Early recognition Early correction Late corrective options are available
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