Complications of fractures

1. ..
COMPLICATIONS OF
By Dr. Ranveer Patel
Orthopaedic Surgeon,
Shreeji Orthopaedic Care

2. FRACTURES
• Fracture is a break in structural continuity of a
bone.
• It is due to sudden direct or indirect trauma
(torsion of leg,vertebral # or avulsion #)
• Or due to stress or fatigue- repetative stress
(athletes,dancers,army personale)
• Or pathological ( osteoporosis,pagets disease ,
bone tumour)

3. CLASSIFICATION
• Complication of fracture tends to classified
according to whether they r local or
symptomatic & when they occur
• 1.Immediate
• 2.Early
• 3.Late

4. IMMEDIATE
• HYPOVOLAEMIC SHOCK
• Commonest cause of death following fractures
• Cause : External/internal haemorrhage
• Treatment :
IV crystelloids : ringer lactate, followed by
colloids & blood

5. EARLY COMPLICACTIONS
• Early complications occur at the time of
fracture (immediate) or soon after
• They are further classified in
1) Local
2) Systemic
Early local complications tend to affect mainly
soft tissues.

6. LOCAL EARLY COMPLICACTIONS
1. Vascular injury causing haemorrhage
2. Visceral injury causing damage to brain,lungs
or bladder.
3. Damage to surrounding tissue,nerves or skin
4. Haemarthrosis
5. Compartment syndrome { volkmann’s
ischemia}

7. ..
6) Wound infection
7) Tetanus
8) Gas gangrene
9) Injury to joints

8. VASCULAR INJURY

9. ..
• Blood vessels lie close proximity to bones
hence liable to injured
• Popliteal is commonly injured one
• Consequences : exercise ischemia – ischemic
contracture- gangrene

10. ..

11. ..

12. VISCERAL INJURIES
• Commonly seen in pelvic & rib fractures
• Pneumothorax or spleen trauma in rib #
• And bladder & urethral rupture in pelvic
injuries.

13. NERVE & SOFT TISSUE DAMAGE
• Radial nerve commonly injured (in shaft
humerus)
• Axillary nerve in shoulder dislocation
• Median nerve in supracondylar humerus-
pointing index
• Ulnar nerve in medial epicondyle humerus-
claw hand
• Sciatic nerve in posterior dislocation of hip-
foot drop

14. ..

15. HAEMARTHROSIS
• Define as bleeding in the joint because of
fracture

16. COMPARTMENT SYNDROME
• A Condition in which increase in pressure
within a closed fascial compartment leads to
decreased tissue perfusion.
• Untreated, progresses to tissue ischaemia and
later on necrosis
• Can also caused by crush injuries or tight casts

17. ..

18. MOST COMMON SITES
• In DECREASING Order:
• Leg (after tibial #) 40%
• Forearm
• Thigh
• Upper arm
• Hand & foot

19. ...

20. MANAGEMENT
• Fasciotomy (relieve/remove external
pressures)
• Decompression of threatened compartment
by open fasciotomy
• Debride necrosis & treat shock urgently

21. ..

22. SYSTEMIC EARLY COMPLICATIONS
• Fat embolism & deep vein thrombosis
• Shock
• ARDS
• Thromboembolism
• Pneumonia
• Septicemia
• Crush syndrome

23. LATE COMPLICATIONS
• Late complications are those which occur after
substantial time has passed & are result of
defective healing process or due to treatment
itself.
• Subclassified in 2 groups
1) Imperfect union of the fracture
2) others

24. OTHER LATE COMPLICATIONS
1. AVASCULAR NECROSIS
2. SHORTNING
3. JOINT STIFFNESS
4. Sudeck’s dystrophy
5. Osteomyelitis
6. Volkmann’s ischemic contracture
7. Osteoarthritis

25. IMPERFECT UNION OF THE FRACTURE
• 4 GROUPS
1. Delayed union
2. Non union
3. Mal union
4. Cross union

26. DELAYED UNION
• When a fracture takes more than usual time to
unite, it is said to have gone to delayed union.
• Union of upper limb: 4-6 weeks
• Union of lower limbs: 8-12 weeks
• Any prolonged time taken is called delayed union
• Causes : inadequate blood supply,
infection
incorrect splintage

27. ..

28. NON UNION
• When the process of fracture healing comes
to a stop before its completion ,fracture is
said to have gone in non union.
• It is not before 6 months that a fracture can
be labelled as nonunion.
• Non union is endpoint of delayed union.
• Pain is diminished , gap in fracture line present
• Fixation with bone graft is necessory

29. ..

30. ..

31. MALUNION
• Occurs when the bone fragments join in an
unsatisfactory position, usually due to insufficient
reduction.
• Causes:
1) Primary : fracture not properly reduced
shortening
2) Secondary : fracture reduced but reduction was
not held
redisplacement after 1 week

32. ..

33. AVASCULAR NECROSIS
• 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.
• It cause deformation of bone and after few
time secondary osteoarthritis develops &
limitation of joint movements.
• Commonest bones involved : Scaphoid
femoral head

34. ..

35. ..

36. OSTEOARTHRITIS
• Fracture joint may damage articular cartilage
& give rise to post traumatic osteoarthritis
within months.
• Later also cause joint stiffness

37. ..

38. ..