A fracture is a medical term used to describe a broken bone. While most fractures can be treated with immobilization and conservative measures, some fractures can lead to complications, especially if they are not treated promptly or appropriately. The following are some common complications of fractures: Delayed union: Delayed union is a condition where the fractured bone takes longer than usual to heal. This can occur due to several factors, including inadequate blood supply to the bone, poor nutrition, or a lack of stability at the fracture site. Malunion: Malunion is a condition where the fractured bone heals in an abnormal position, resulting in deformity or misalignment. This can occur due to inadequate reduction (alignment) of the fracture, inadequate immobilization, or other factors. Nonunion: Nonunion is a condition where the fractured bone fails to heal even after an extended period of time. This can occur due to several factors, including poor blood supply, infection, or inadequate immobilization. Infection: Fractures can also lead to infections, particularly if the bone is exposed or there is an open wound at the fracture site. This can lead to complications such as osteomyelitis, a serious bone infection that can require long-term antibiotics or surgery to treat. Compartment syndrome: Compartment syndrome is a condition where increased pressure within a muscle compartment causes reduced blood flow and tissue damage. This can occur after a fracture, particularly if there is significant swelling or bleeding in the affected area. Nerve damage: Fractures can also lead to nerve damage, particularly if the fracture is near a nerve. This can lead to symptoms such as numbness, tingling, or weakness in the affected area. Blood vessel damage: Fractures can also cause damage to blood vessels, leading to bleeding or reduced blood flow to the affected area. It is important to seek prompt medical attention if you suspect a fracture, to ensure appropriate diagnosis and treatment and to minimize the risk of complications.

1. COMPLICATION OF FRACTURE
Muhammad Wasil Khan
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2. GENERAL
COMPLICATIONS
1. Shock
2. Diffuse coagulopathy
3. Crush syndrome
4. Venous thrombosis & Pulmonary embolism
5. Fat embolism
6. Gas Gangrene
7. Tetanus

3. SHOCK
● Altered physiologic status with generalized inadequate tissue perfusion relative to metabolic requirements
irreversible damage to vital organs
● Cardiogenic
● Neurogenic
● Hypovolemic

4. DIFFUSE COAGULOPATHY
● Acute Traumatic Coagulopathy occurs immediately after massive trauma when shock, hypoperfusion, and vascular
damage are present. Mechanisms for this acute coagulopathy include activation of protein C, endothelial glycocalyx
disruption, depletion of fibrinogen, and platelet dysfunction

5. CRUSH SYNDROME
[TRAUMATIC RHABDOMYOLITIS]
● Serious medical condition characterized by major shock & renal failure following a crushing injury to skeletal
muscles

6. DEEP VEIN THROMBOSIS
AND PULMONARY EMBOLISM.

7. FAT EMBOLISM
● Fat globules from marrow pushed into circulation by the force of trauma that causing embolic phenomena

8. GAS GANGRENE
● Rapid and extensive necrosis of the muscle accompanied by gas formation and systemic toxicity due to clostridium
perfringens infection

9. TETANUS
● A condition after clostridium tetani infection that passes to anterior horn cells where it fixed and cant be
neutralized later produces hyper-excitability and reflex muscle spasm

10. EARLY
COMPLICATIONS
1. Visceral Injury
2. Vascular Injury
3. Compartment Syndromes
4. Nerve injury
5. Haemarthrosis
6. Infection

11. VISCERAL INJURY
● Fractures around the trunk are often complicated by visceral injury.
● E.g. Rib fractures causing pneumothorax / spleen trauma/ liver injuries.
● E.g. Pelvic injuries causing bladder or urethral rupture / severe hematoma in the retroperitoneum

13. VASCULAR INJURY
● Commonly associated with high energy open fractures.

14. COMPARTMENT SYNDROME
● A condition in which increase in pressure within a closed fascial compartment leads to decreased tissue perfusion.
Untreated, progresses to tissue ischemia and eventual necrosis.
● Most common sites (in ↓ freq): leg (after tibial fracture) → forearm → thigh → upper arm. Other sites: hand, foot,
abdomen, gluteal and cervical regions.

16. NERVE INJURY
● It’s more common than arterial injuries.
● The most commonly injured nerve is the radial nerve [in its groove or in the lower third of the upper arm especially in
oblique fracture of the humerus]
● Common with humerus, elbow and knee fractures
● Most nerve injuries are due to tension neuropraxia.

17. Clinical Features
● Numbness and weakness
● Skin smooth and shiny but feels dry
● Muscle wasting and weakness
● Sensation blunted
● Tinel’s sign +ve

18. HAEMARTHROSIS
Bleeding into a joint spaces.
Occurs if a joint is involved in the fracture.
Presentation:
swollen tense joint; the patient resists any attempt to moving it
● Blood aspiration before dealing with the fracture; to prevent the development of synovial adhesions.

19. INFECTION
● Closed fractures – hardly ever
● Open fractures – may become infected
● Post traumatic wound – may lead to chronic osteomyelitis

20. LATE
COMPLICATIONS
1. Delayed Union
2. Non-union
3. Mal-union
4. Avascular Necrosis
5. Osteoarthritis

21. DELAYED UNION
● Union of the upper limbs - 4-6 weeks
● Union of the lower limbs - 8-12 weeks(rough guide)
● Any prolong time taken is considered delayed

22. NON-UNION
● fracture that persists for a minimum of nine months without signs of healing for three months.
● bone ends are rounded off or exuberant

23. MALUNION
● fragments that are joined in an unsatisfactory position

24. AVASCULAR NECROSIS
● Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, it can lead to
tiny breaks in the bone and the bone's eventual collapse. A broken bone or dislocated joint can interrupt the blood
flow to a section of bone.

25. OSTEOARTHRITIS
● A fracture-joint may damage the articular cartilage and give rise to post traumatic osteoarthritis within a period of
months.
● Even if the cartilage heals, irregularity of the joint surface may cause localized stress and so predispose to secondary
osteoarthritis years later