Complications of fractures of bones
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The document discusses the complications associated with fractures, including immediate, early, and late complications. Immediate complications include hypovolemic shock and vascular injuries, while early and late complications involve issues such as compartment syndrome, non-union, and avascular necrosis. The management strategies for these complications, including surgical interventions and the importance of proper healing, are also outlined.
Complications of fractures of bones
- 1. .. COMPLICATIONS OF By Dr. Ranveer Patel Orthopaedic Surgeon, Shreeji Orthopaedic Care
- 2. FRACTURES • Fracture is a break in structural continuity of a bone. • It is due to sudden direct or indirect trauma (torsion of leg,vertebral # or avulsion #) • Or due to stress or fatigue- repetative stress (athletes,dancers,army personale) • Or pathological ( osteoporosis,pagets disease , bone tumour)
- 3. CLASSIFICATION • Complication of fracture tends to classified according to whether they r local or symptomatic & when they occur • 1.Immediate • 2.Early • 3.Late
- 4. IMMEDIATE • HYPOVOLAEMIC SHOCK • Commonest cause of death following fractures • Cause : External/internal haemorrhage • Treatment : IV crystelloids : ringer lactate, followed by colloids & blood
- 5. EARLY COMPLICACTIONS • Early complications occur at the time of fracture (immediate) or soon after • They are further classified in 1) Local 2) Systemic Early local complications tend to affect mainly soft tissues.
- 6. LOCAL EARLY COMPLICACTIONS 1. Vascular injury causing haemorrhage 2. Visceral injury causing damage to brain,lungs or bladder. 3. Damage to surrounding tissue,nerves or skin 4. Haemarthrosis 5. Compartment syndrome { volkmann’s ischemia}
- 7. .. 6) Wound infection 7) Tetanus 8) Gas gangrene 9) Injury to joints
- 9. .. • Blood vessels lie close proximity to bones hence liable to injured • Popliteal is commonly injured one • Consequences : exercise ischemia – ischemic contracture- gangrene
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- 12. VISCERAL INJURIES • Commonly seen in pelvic & rib fractures • Pneumothorax or spleen trauma in rib # • And bladder & urethral rupture in pelvic injuries.
- 13. NERVE & SOFT TISSUE DAMAGE • Radial nerve commonly injured (in shaft humerus) • Axillary nerve in shoulder dislocation • Median nerve in supracondylar humerus- pointing index • Ulnar nerve in medial epicondyle humerus- claw hand • Sciatic nerve in posterior dislocation of hip- foot drop
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- 15. HAEMARTHROSIS • Define as bleeding in the joint because of fracture
- 16. COMPARTMENT SYNDROME • A Condition in which increase in pressure within a closed fascial compartment leads to decreased tissue perfusion. • Untreated, progresses to tissue ischaemia and later on necrosis • Can also caused by crush injuries or tight casts
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- 18. MOST COMMON SITES • In DECREASING Order: • Leg (after tibial #) 40% • Forearm • Thigh • Upper arm • Hand & foot
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- 20. MANAGEMENT • Fasciotomy (relieve/remove external pressures) • Decompression of threatened compartment by open fasciotomy • Debride necrosis & treat shock urgently
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- 22. SYSTEMIC EARLY COMPLICATIONS • Fat embolism & deep vein thrombosis • Shock • ARDS • Thromboembolism • Pneumonia • Septicemia • Crush syndrome
- 23. LATE COMPLICATIONS • Late complications are those which occur after substantial time has passed & are result of defective healing process or due to treatment itself. • Subclassified in 2 groups 1) Imperfect union of the fracture 2) others
- 24. OTHER LATE COMPLICATIONS 1. AVASCULAR NECROSIS 2. SHORTNING 3. JOINT STIFFNESS 4. Sudeck’s dystrophy 5. Osteomyelitis 6. Volkmann’s ischemic contracture 7. Osteoarthritis
- 25. IMPERFECT UNION OF THE FRACTURE • 4 GROUPS 1. Delayed union 2. Non union 3. Mal union 4. Cross union
- 26. DELAYED UNION • When a fracture takes more than usual time to unite, it is said to have gone to delayed union. • Union of upper limb: 4-6 weeks • Union of lower limbs: 8-12 weeks • Any prolonged time taken is called delayed union • Causes : inadequate blood supply, infection incorrect splintage
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- 28. NON UNION • When the process of fracture healing comes to a stop before its completion ,fracture is said to have gone in non union. • It is not before 6 months that a fracture can be labelled as nonunion. • Non union is endpoint of delayed union. • Pain is diminished , gap in fracture line present • Fixation with bone graft is necessory
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- 31. MALUNION • Occurs when the bone fragments join in an unsatisfactory position, usually due to insufficient reduction. • Causes: 1) Primary : fracture not properly reduced shortening 2) Secondary : fracture reduced but reduction was not held redisplacement after 1 week
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- 33. AVASCULAR NECROSIS • Blood supply of some bones is such that the vascularity of a part of it is seriously jeopardized following fracture, resulting in necrosis of the part. • It cause deformation of bone and after few time secondary osteoarthritis develops & limitation of joint movements. • Commonest bones involved : Scaphoid femoral head
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- 36. OSTEOARTHRITIS • Fracture joint may damage articular cartilage & give rise to post traumatic osteoarthritis within months. • Later also cause joint stiffness
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