2.  •Complications of fractures tend to be
classified according to whether they
are local or systemic and when they
occur –
 IMMEDIATE
 EARLY
 LATE

3.  HYPOVOLAEMIC SHOCK
 Commonest cause of death following
fractures
 Cause- external/internal haemorrhage
 Treatment
 Iv crystalloids-ringer lactate,followed by
colloids and blood

4.  •Early complications occur at the time
of the fracture (immediate) or soon
after.
 •They are again classified into-
 local
 Systemic
 •Early local complications tend to
 affect mainly the soft tissues

5.  •Vascular injury causing haemorrhage,
 internal or external
 •Visceral injury causing damage to
 structures such as brain, lung or bladder
 •Damage to surrounding tissue, nerves or
 skin
 •Haemarthrosis
 •Compartment syndrome {volkmanns
ischemia}

6. 
 •Wound Infection, more common for open
 fractures
 •Tetanus

•Gas gangrene

•Injury to joints

8.  Blood vessels lie close proximity to bones
,hence liable to injured
 Popliteal is commonly injured one
 Consequences- exercise ischemia-ischemic
contracture-gangrene
 Signs-5ps-pain,absent
pulse,pallor,parasthesia,paralysis

11.  Commonly seen in
pelvic and rib
fractures

13.  Radial nerve is commonly injured
 Consequences- lead to
neurapraxia,axonotmesis or neurotmesis
 Axillary n-dislocatn of shoulder-deltoid
paralysis
 Radial n-#shaft of humerus-wrist drop
 Median n-supracondylar# of humerus-pointing
index
 Ulnar n-#medial epicondyle humerus-claw
hand
 Sciatic n- posterior dislocation of hip-foot
drop

14.  Bleeding in the joint because of fracture

15.  •Fractures of the limbs can cause severe
ischaemia, even without damage to a major blood
vessel
 •. Bleeding or oedema in an osteofascial
compartment increases pressure within the
compartment, reducing capillary flow and causing
muscle ischaemia
 •A vicious circle develops of further oedema and
pressure build-up, leading swiftly to muscle and
nerve necrosis.
 Limp amputation may be required if untreated

16.  •Compartment syndromes can also
 result from ;
 Crush injuries caused by falling debris or
from a patient’s unconscious compression
of their own limb
 Swelling of a limb inside an over tight cast

17. 
 •Compartment syndrome can occur in any
compartment, e.g. the hand, forearm,
upper arm, abdomen, buttock, thigh, and
leg.
 •40% occur following fracture of the shaft
of the tibia (with an incidence of 1-10%)
and about 14% following fracture of a
forearm bone.
 •Risk is highest in those under 35 years

19. 
Presentation:-
 Signs of ischaemia (5 P's: Pain,Paraesthesia,
Pallor, Paralysis,Pulselessness)
 Signs of raised intracompartmental
 pressure:
 1.Swollen arm or leg
 2.Tender muscle - calf or forearm pain on
 passive extension of digits
3.Pain out of proportion to injury
4.Redness, mottling and blisters
 Watch for signs of renal failure{low-output
uraemia with acidosis)

21.  Remove/relieve external pressures
 (fasciotomy)
 Prompt decompression of threatened
 compartments by open fasciotomy
 Debride any muscle necrosis
 Treat hypovolaemic shock and oliguria
 urgently
 Renal dialysis may be necessary

22.  •Complications
 Acute renal failure secondary to
 rhabdomyolysis
 DIC
 Volkmann's contracture (where infarcted
muscle is replaced by inelastic fibrous
tissue)

23.  •Clostidium welchii (
perfringens )
 •Clinical presentation
 Subcutaneous
crepitations
 Myonecrosis
 •Treatment
 Debridement
 pencillin

24.  Causative agent

Clostidium tetani
 TRISMUS
 DYSPHAGIA
 RISUS SARDONICUS
 OPIS THOTONUS
 Treatment
 Bed rest and
sedation
 Immunoglobulin
 Respiratory
support
 pencillin

25.  •Fat embolism
•Shock
•ARDS
•Thromboembolism (pulmonary or venous)
 •Exacerbation of underlying diseases
 such as diabetes or CAD
 Pneumonia
 Aspectic traumatic fever
 Septicemia
 Crush syndrome

26.  •This is a relatively uncommon disorder that occurs
in the first few days following trauma with a
mortality rate of 10-20%
 •Fat drops are thought to be released mechanically
from bone marrow following fracture, coalesce and
form emboli in the pulmonary capillary beds and
brain, with a secondary inflammatory cascade and
platelet aggregation
 •An alternative theory suggests that free fatty acids
are released as chylomicrons following hormonal
changes due to trauma or sepsis

27. 
 •Risk factors
 Closed fractures
Multiple fractures
Pulmonary contusion
Long bone/pelvis/rib fractures

28.  •Sudden onset dyspnoea
•Hypoxia
•Fever
•Confusion, coma, convulsions
•Transient red-brown petechial rash
 affecting upper body,especially axilla
 Diagnosis
 Retinal artery emboli-striate hges & exudates
 Sputum & urine-fat globules
 X-ray chest –snow storm appearance

30.  Respiratory support
 Heparinisation
 Intravenous low molecular weight
 dextran(lomodex 20) and corticosteroids
 Iv 5% dextrose solution with 5% alcohol –helps
in emulsification of fat globules

31.  Common complication associated with lower
 limb injuries and with spinal injuries
 •D.V.T. proximal to the knee
is a common cause of life
threatening complication of pulmonary embolism
 Causes
 Immobilization following trauma
 Fracture of leg
Symptoms
Leg swelling
Calf tenderness

32.  pulmonary embolism
 Tachypnoea
 Dyspnoea
 4-5 days after trauma
 •Treatment:-
 Elevation of the limb
 Anti coagulating therapy
 Respiratory support and heparin therapy{
 respiratory embolism}
 Early internal fixation of fractures
 Active mobilization of the extremity

33.  •Aseptic traumatic fever: This is
supposed to be due to absorption of
fibrin ferment taking place.
 •It may, however, be due to some
irritation, as of a badly fitting splint,
and disappears on removal of it

34.  •Because of trauma a large amount of
bacteria can enter in the blood stream and
may cause septicemia
 Symptoms
 Rash
 Fever and vomiting
 Cold extremitis
 Rapid breathing
 Stomach pain and joint pain
 drowsy

35.  Initial Resuscitation - ABC
 1.Secure airway
 2. Support breathing
 3.Restore circulation
 Fluid therapy
 Inotropic Support
 Antimicrobial therapy
 Respiratory Support

36.  •Crushing injury to skeletal muscles
 because of the fracture
 Cause- crushing of muscles- myohb enters to
circulation-ppt in renal tubules-a/c renal
failure
 •Complications
 shock
 Renal failure
 •Management
 To avert disaster, a limb crushed severely
 and for several hours should be amputated

37.  •Late complications are those which occur
after a substantial time has passed and
are as a result of defective healing
process or because of the treatment itself.
 •They are again classified in to 2 groups
 Imperfect union of the fracture
 others

38.  •Avascular necrosis
•Shortening
•Joint stiffness
•Sudeck’s dystrophy
•Osteomyelitis
•Volkmann’s Ischaemic contracture
•Myositis ossificans
•Osteoarthritis

39.  •They are again classified into four sub
 groups:
 Delayed union
 Non union
 Mal-union
 Cross-union

40.  •When a fracture takes more than the
usual time to unite, it is said to have
gone in delayed union
 •Causes:
 Inadequate blood supply
 infection
 Incorrect splintage
 1.Insufficient splintage
 2.excessive traction

41.  •Signs:
 The fractured site is usually tender
 The bone may appear to move in one piece,
if however, it is subjected to stress , pain is
immediately felt and the bone may angulate;
 The fracture is not consolidated
 X-ray: the fractured site is still clearly
visible,
 but the bone ends are not sclerosed

43. 
 Conservative:
 1.Plaster should be sufficiently extensive and
 must fit accurately
2.Replace traction by plaster splintage
3.Use of functional bracing
 Operative:
 Bone grafting with or without IF

44.  •When the process of fracture healing
comes to a stand before its
completion, the fracture is said to
have gone in non –union.
 •It is not before six months that a
 fracture can be so labelled.
 Nonunion is one endpoint of delayed union

45.  The injury
 1.Soft tissue loss
 2. Bone loss
 3.Intact fellow bone
 4.Soft tissue inter position
 The bone
 1.Poor blood supply
 2. Poor haematoma
3. Infection
4. Pathological lesion

46.  Pain at fracture site
 Nonuse of extremity
 Tenderness and swelling
 Joint stiffness (prolonged >3 months)
 Movement around the fracture site (pseudarthrosis)
 Investigations
 Absence of callus (remodelled bone) or lack of
progressive change in the callus suggests delayed
union.
 Closed medullary cavities suggest nonunion.
 Radiologically, bone can look inactive, suggesting the
area is avascular (known as atrophic nonunion) or
there can be excessive bone formation on either side
of the gap (known as hypertrophic nonunion).

48.  Conservative:
 1.Occasionally symptom less, needing no
 treatment
 2.Functional bracing may be sufficient to induce
 union
 3.Electrical stimulation promotes osteogenesis
 Operative
 1.Very rigid internal fixation with hypertrophic
 non-union
 2.Fixation with bone graft is needed in case of
atrophic non union

49.  occurs when the bone fragments join in an
unsatisfactory position, usually due to insufficient
reduction.
 Causes
 primary
 1.The fracture was never reduced and has united
 in a deformed position.
 2.Shortening is, of course, one type of deformity.
 Secondary
 1.The fracture was reduced but the reduction was
not held
 2.Redisplacementmay occur during the first
 week, and a check x-ray at 1 week is adviseable

50. .
 •Signs:
 The deformity is usually obvious
 There may be painful limitation of joint
 movements
 At elbow, valgus deformity may present
 with delayed ulnar nerve palsy

51.  Conservative
 1.If shortening is the main feature a raised shoe
 is usually sufficient
 2.In child usually no treatment is required
because it is expected to correct by
remodelling
 Operative
 1. Osteotomy
 2.Excision of protruding bone
 3. Osteoclasis
 4.Redoing the fracture surgical

52.  •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.

54.  Avascular necrosis causes
deformation of the bone. This leads, a
few years later, to secondary
osteoarthritis and causes painful
limitation of joint movement.
 Diagnosis:-
 X-ray changes:--
 1.Sclerosis of the necrotic area
 2.Deformity of the bone
 3. Osteoarthritis
 Bone scan:- changes can be seen
 before X-ray changes:
 1.Visible as cold area on the bone

56.  •Treatment:- Avascular necrosis can
be prevented by early, energetic
reduction of susceptible fractures
and dislocations. Treatment options:
 1.Delay weight bearing till revascularization
 to prevent collapse
 2. Revascularization
 3.Excision of the avascular segment
 4.Total joint replacement

57.  •It is a common complications of
 fractures and results from:-
 1.Mal union of the long bones
2.Crushing: Actual bone loss
3.Growth defects: growth plate or epiphyseal
injuries

58.  Shortening of upper limbs goes unnoticed
 For lower limb treatment depends upon the
 amount of shortening:
 1.Shortening less than 2 cm: compensated by
 shoe raise
 2.Shortening more than 2 cm: limb length
 equalization procedures

60.  •It is a common complications of
 fracture treatment.
 •Shoulder, elbow and knee joints are
particularly prone to stiffness
following immobilization

61.  Intra-articular or Para-articular adhesions
 secondary to immobilizations
 Contracture ofthe musclesaround a joint
 because of prolonged immobilizations
 Tethering of muscles at fracture site
 Myositis ossificans
 •Consequences:-
 Hampers the normal physical activity
 Results in late osteoarthritis

62.  Heat therapy and exercise
 Manipulation of the joint under anesthesia
 Surgical interventions
 1.To excise an extra articular bone block
2.To lengthen contracted muscles
3.Joint replacement, if there is pain due to
secondary arthritis

63.  •Also known as Reflex Sympathetic
 Dystrophy.
 •Involves a disturbance in the
 sympathetic nervous system.
 •Consequences:-
 pain
 Hyperaesthesia
 Tenderness
 Swelling

64.  Skin become red, shiny and warm in early
 stages
 Progressive atrophy of the skin, muscles and
 nails in later stages
 Joint deformity and stiffness ensues
 X-ray shows characteristic spotty rarefraction

65.  Occupational therapy and physiotherapy
 constitutes the principle modality of
 treatment.
 Use of β-blocker.
 In resistant cases, sympathetic blocks have
 been shown to aid in recovery

66.  •Osteomyelitis is an infection of a
 bone.
 •Many different types of bacteria can
 cause osteomyelitis.
 •However, infection with a bacterium
called Staph. aureus is the most
common cause. Infection with a
fungus is a rare cause

68.  •After operative treatment of fracture
bacteria may spread to the bone and
may cause osteomyelitis.

antibiotics
 Surgery:
 1.in case of abscess formation
 2.The infection presses on other important
 structures
 3.The infection has become 'chronic' (persistent)
 and some bone has been destroyed.
 4. Hyperbaric oxygen

69.  •This a sequel to Volkmann's
 ischaemia.
 •The ischaemic muscles are replaced
 by fibrous tissue
 •If the peripheral nerves are also
affected, sensory or motor paralysis
may happen

Clinical features:-
 Marked atrophy
 Flexion deformity
 Nails shows atrophic changes
 Skin becomes dry and scaly

71.  Mild deformity can be corrected by passive
stretching using a turn-buckle splint
(Volkmann's splint)
 For moderate deformities, a soft tissue
sliding
operation, where the flexor muscles are
released from their origin, is performed
 For a severe deformity, bone shortening
 operations may be required

72.  •Myositis ossificans is where
calcifications and bony masses
develop within muscle and can occur
as a complication of fractures.
 •It may also happens because of the
ossification of the hematoma around a joint
after a compound fractures

74.  Pain
 Tenderness ,
 Focal swelling, and
 Joint/muscle contractions
 •Treatment:-
 Massage following injury is strictly
prohibited.
 In early stages rest is advised
 NSAIDS may help to reduce pain

75.  In late stages Occupational and
 Physiotherapy is prescribed to regain
 movements
 Ultra sound
 In some cases surgical excision of myositic
 mass is done

76.  •Osteoarthritis is liable to follow
malunion and traumatic injuries to the
joints.
 •Joint surfaces become incongruent
 •Direction of stress transmission is
 abnormal
 •Increase wear and tear at the joint

78.  Osteoarthritis cannot be cured,
 but it can be treated
 The goal of every treatment for
 arthritis is to:-
 1.reduce pain and stiffness,
2.allow for greater movement, and
3.slow the progression of the disease
 Anti-Inflammatory Medications

79.  Cortisone Injections
 Occupational and physiotherapy
 Weight Loss
 Activity Modification
 Diet: obesity is a risk factor for developing
 osteoarthritis

80.  Casts
 Pressure ulcers
 Thermal burns during plaster hardening
 Thrombophlebitis

81.  Traction prevents patients mobilising,
causing additional muscle wasting and
weakness. Other complications include:
 Pressure ulcers
 Pneumonia/urinary tract infections
 Permanent footdrop contractures
 Peroneal nerve palsy
 Pin tract infection
 Thromboembolism

82.  Problems include:
 Pin tract infection
 Pin loosening or breakage
 Interference with movement of the joint
 Neurovascular damage due to pin placement
 Misalignment due to poor placement of the
fixator
