COMPLICATIONS OF FRACTURES

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GENERAL
 
COMPLICATIONS
1. Internal and external hemorrhage, shock (whether neurogenic, septic or
hypovolumic shock).
2. Systemic Infection in open or compound injuries
3. Electrolyte shifts, protein breakdown.
4. COMPLICATIONS OF PROLONGED RECUMBENCY

5. COMPLICATIONS OF ANAESTHESIA AND SURGERY

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 4-COMPLICATIONS OF PROLONGED RECUMBENCY

 Hypostatic pneumonia
 Pressure sores.
 Deep venous thrombosis and pulmonary embolism.
 Muscle wasting and stiffening of joints.
 Skeletal de-calcification (osteoporosis) and the formation of urinary tract
calculi
 Urinary tract infections.
 Cardiovascular complications. poor venous return
 Psychiatric complications such as depression

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Cont…
 Neurological complications such as:
1- Common peroneal nerve palsy. This sometimes results from a less than
ideal posture of the leg when external rotation leads to pressure in the
region of the fibular neck, or it sometimes occurs from pressure against a
splint
2- Ulnar neuropathy. Front the patient repeatedly trying to change position
using downwards pressure of the elbows against the bed
 Cardiovascular complications. poor venous return
 Psychiatric complications such as depression

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5. COMPLICATIONS OF ANAESTHESIA AND SURGERY

 Atelectasis and pneumonia breathing ex’s

 Blood loss leading to anemia or shock with their secondary effects.
 Wound infection Mechanical failure of internal fixation devices. etc.

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LOCAL COMPLICATIONS

1-union problems
2-Joint stiffness
3-Complex regional pain syndrome
4-Avascular necrosis is death
5-Myositis ossifficans
6-Local Infections. (Osteitis/Osteomyelitis
8-Fat embolism
9-nerve injury
10-Implant complication.

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LOCAL COMPLICATIONS
1-union problems
A-Non-union the fracture has failed to unite and
there are radiological changes which indicate that
this situation will be permanentn.
 Types:
 Hypertrophic non-union (macro motion) the hone
ends appear sclerotic and are flared out 'elephant's
foot' appearance, the fracture line is clearly
visible, the gap being filled with cartilage and
fibrous tissue cells due to good blood supply.
 Atrophic non-union (poor blood supply) The
bone ends are narrow, rounded and osteoporotic:
They are frequently avascular.

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B-delayed union the fracture takes longer
than usual to unite but passes through the
stages of healing without any departure
from normal clinically or radiological

C-Mal-union In theory, fracture has united in

less than anatomical position.
 Angulation
 Rotation
 Shortening
shortening
 Translation

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2-Joint stiffness.
 intra-articular causes of stiffness:
-Organization of a hemo-arthrosis
-Damage to the articulating (cartilaginous) surfaces
 Peri-articular causes of stiffness:
-Joint capsules and musculo-tendinous cuffs may become functionally impaired.
-Edema
 Stiffness from causes remote from a joint
-Muscle adhesions forming between fractures and overlying muscle.

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3-Complex regional pain syndrome (Sudek's atrophy, reflex
sympathetic dystrophy, ). It is a chronic pain condition where
that suggests over activity of the sympathetic nervous
system, CNS, PNS mechanisms.
 pain
 Hyperalgesia excessive sensitivity to pain
 History of edema,
 change in skin blood flow or abnormal sweating in the
region of pain
 atrophy

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4-Avascular necrosis is death of bone due to interference with its blood supply.
This is seen in the femoral head after intra-capsular fractures of the femoral
neck or after dislocation of the hip.

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5-Myositis ossifficans. Calcified mass appears in the tissues near a joint,
leading generally to considerable restriction of movements The commonest
site is the elbow is also seen at other sites especially the shoulder, knee
and hip

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6-Local Infections. (Osteitis/Osteomyelitis)
a common complication of open fractures, and is seen on occasion after
the internal fixation of closed (or open) fractures.

7-  Local vascular complications.

Classical presentation of ischemia 5 Ps:
Pain , Pallor, Pulseless , Paralysis , and Paraesthesia

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Cont…
1-Compartment syndrome
 Most commonly in forearm and calf's.
Muscles are arranged in different compartments and
surrounded by one fascia , this arrangement called
osteofascial compartment.
Compartment syndrome occurs when muscle swells within
osteofacial compartment and occludes its blood supply >>
ischemic contracture.
reasons that lead to increase the pressure inside:
1. Bleeding
2. Edema

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 Reduction
Arterial ischemia of blood
damage flow

Increase
edema
pressure
Direct injury

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Cont…
 this vicious circle ends in necrosis of nerves and muscles within the
compartment.
Nerve are capable of regeneration, but the muscle once infarcted can never
recover and are replaced by fibrous tissue. This condition is called volkmann
s ischemic contracture.
 2-Volkmann’s ischemic contracture

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8-Fat embolism

Usually occurs in young adult after closed fractures of long bone .

Characterized by occlusion of the small blood vessels by fat globules.

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 Fat in bone Formation of
Closed/open
marrow fat globules in
Fracture vessels
escape

Trigger Stick in
clotting pulmonary Fat embolus
cascade bed

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9-Nerve injury
Injury Nerve palsy
Dislocation of the shoulder Axillary nerve palsy; rarely. other brachial
plexus lesions

fracture of the shaft of the hummers Radial nerve palsy

Dislocation of the elbow Ulnar nerve palsy. sometimes median nerve

affected

Fractures around the elbow Median palsy, ulnar nerve or posterior

interosseous nerve

Dislocation of the hip Sciatic nerve palsy

Dislocation of the knee Medial tibial nerve palsy
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10-Implant complication.
 Stress concentrations tend to occur at the ends of internal fixation devices.
This lead to susceptibility to fracture,

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Thanks