Fracture Complication

Late complication
Shoban Raj a/l Vasudayan
 Late complications of #
• Skeletal • Soft tissue
 Delayed union  Myositis ossificans
 Malunion  Nerves
 Non – union  Tendon
 AVN
 OA • Involving the whole/
 Growth disturbance part of limb
 Reflex sympathetic
dystrophy
 Outline
• Delayed union • Growth disturbance
• Non-Union • Joint instability
• Malunion • Osteoarthritis
• Avascular necrosis • Others
 Delayed Union
• Process of union occurs at a rate slower than
expected
• No absolute time
• Perkin’s Law as a guide

Features ( Clinical): X-ray

1. Pain  Fracture line remains
 Little callus formation
2. Mobile
 Bone are not sclerosed or atrophic
 Tx:
Infection
Poor
Blood
• Eliminate any possible
supply cause
• Promote healing by
providing appropriate
Severe
Over rigid
fixation
soft tissue environment
damage

• Operative  delayed for > 6

Imperfect Periosteal
months without signs of
splintage stripping callus formation
 Non Union
• Fracture fails to unite in the maximum
permisible time.
• Will never unite without intervention 
pseudoarthrosis

X-ray:
Clinical features:
• # clearly visible
• Mobile
• hypertrophic non – union
• Without pain
• atrophic non – union

Tx:
• Conservative – functional bracing, pulsed electromagnetic field, low
frequency pulsed USD
• Operative
 Malunion
• Fragments joins in an unsatisfactory position
Angulation
Rotation
Shortening

Tx:
 Adults: # should be reduced as near as to anatomical position, angulation
> 10-15° need  re-manipulation, ostetomy, internal fixation

 Young children: angular deformity remodels but not rotational deformity !!

 Lower limb shortening > 2cm unacceptable !!!

 Patients expectation should not be ignored

 Avascular necrosis
• Regions prone for avascular necrosis:
 Head of femur
 Proximal part of scaphoid
 Lunate
 Body of Talus

• Ischemia ( few hours after #)  ?? clinical and

radiological feature

• Tx: Re-vascularization, excision of avascular segment,

arthrodesis, joint replacement
 Growth disturbance
• In children – injury to the physis
• Lead to abnormal/ arrested growth
 Joint instability
• Bone loss/ malunion close to a joint 
instability or recurrent dislocation

• Common site: shoulder, elbow and patella

 Osteoarthritis
• Post traumatic osteoarthritis ( within 6-9
months)

• Secondary osteoarthritis  years later

 Others
• Complex regional pain syndrome
• Myositis ossificans – joint stiffness
• Late nerve palsy – Tardy nerve palsy
THANK YOU 