This document discusses early and delayed complications that can arise from fractures. Early complications include visceral injuries to organs like the brain, chest, abdomen, and pelvis. Vascular injuries such as cuts, compression, thrombosis, or spasm of major arterial vessels can also occur. Compartment syndrome, which is an increase in pressure within a closed muscle compartment, is another potential early complication. Delayed complications include delayed union, malunion, non-union, avascular necrosis, joint instability, growth disturbances, and osteoarthritis.

1. Complications of fractures

2. Early complications
 Visceral Injury
 Brain
 Chest
 Abdomen
 Pelvic Organs

3. Vascular Injury
 Injury to major arterial vessels
 Cut
 Compressed
 Thrombosed
 Spasm
 5 Ps
 Dry Gangrene

4. Assessment
 Type of injury
 Remove cast/splint/
bandages
 X ray suggestive of areas
with vessel at risk

5. COMPARTMENT SYNDROME
 Increase in the interstitial pressure of a closed osseo-fascial compartment
 Compartment pressure > 30mmHg
 Difference of <30mmHg in from diastolic pressure
 In Normotensive patients
 Leg
 Forearm
 Thigh
 Hand & Foot
 Open Fracture?

6. Causes
Internal
 Haematoma
 Coagulopathy
 Seizure/Rhabdomyolysis
 Snake bite
 Reperfusion injury
 Vascular injury
 DVT
 Idiopathic
External
 Trauma
 Burns
 Compression from heavy
object/ tight cast/ splint

8. Clinical features
 Pain
 Pulselessness
 Paresthesia
 Pallor
 Palpably tense compartment
 Passive stretch pain

9.  Investigations?
 Compartmetn pressure
 Mostly clinical
 Treatment
 Remove all tight bandages/ compression
 Early presentation- Fasciotomy
 >48 hours – conservative
 Expect VIC
 Fluids.
 Monitor Urine output and Kidney function

11. Outcome
 Ischaemia resolved
 Regeneration of nerves and
Vessels
 Muscle undego necrosis---
fibrosis---
 Volksmann ischaemic
contracture

12. Delayed complications
1. Delayed union
2. Mal-union
3. Non –union
4. Avascular necrosis
5. Joint instability
6. Growth disturbances
7. Osteoarthritis

13. References
 Essential Orthopaedics by J. Maheshwari
 Rockwood and Green’s Fracture in adults (5th Edition).
 Textbook of Orthopaedics and Trauma (3rd edition) by G.S Kulkarni
 www.google.com ( Image search)
 www.slideshare.net