Late complications of fractures

Posted by e-Medical PPT
Local
    * Delayed union
    * Nonunion
    * Malunion
    * Joint stiffness
    * Contractures
    * Myositis ossificans
    * Avascular necrosis
    * Algodystrophy (or Sudeck's atrophy)
    * Osteomyelitis
    * Growth disturbance or deformity

Systemic
    * Gangrene, tetanus, septicaemia
    * Fear of mobilising
    * Osteoarthritis

Nonunion is where there are no signs of healing after >3-6 months (depending upon the site of fracture). Nonunion is one endpoint of delayed union. Malunion occurs when the bone fragments join in an unsatisfactory position, usually due to insufficient reduction.
Causes of delayed union include:
    * Severe soft tissue damage
    * Inadequate blood supply
    * Infection
    * Insufficient splintage
    * Excessive traction
Nonunion occurs in approximately 1% of all fractures but is more common in lower leg fractures (19% nonunion) or where there is motion at the fracture site.
Nonsurgical approaches such as early weight bearing and casting may be helpful for delayed union and nonunion.
Surgical treatments include:
    * Debridement to establish a healthy infection-free vascularity at the fracture site
    * Internal fixation to reduce and stabilise the fracture.
    * Bone grafting to stimulate new callus formation.

Avascular necrosis
Certain regions are known for their propensity to develop ischemia and necrosis after injury.
It’s Early complication because ischemia occurs during the first few hours but the clinical and radiological effects are seen until weeks or months later . Avascular necrosis causes deformation of the bone. This leads, a few years later, to secondary osteoarthritis and causes painful limitation of joint movement.


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