Local Complications of Fractures

Posted by e-Medical PPT
Visceral injury:
Fractures around the trunk are often complicated by visceral injury. E.g. Rib fractures are associated with life threatening pneumothorax or with spleen, liver injuries. E.g. Pelvic injuries are associated with bladder or urethral rupture and cause sever hematoma in the retroperitoneum .Surgery of visceral injuries should take precedence over the treatment of fracture.
Vascular Injuries:
Most associated with injuries around knee, elbow, humerus and femoral shaft.
Commonly associated with high-energy open fractures.
They are rare but well-recognized.
Cause : From initial trauma or from bone fragment
Mechanism of injuries:
** The artery may be cut or torn.
** Compressed by the fragment of bone.
** normal appearance with intimal detachment that lead to thrombus formation.
** segment of artery may be in spasm.
Classical presentation of ischemia 5 Ps: Pain , Pallor, Pulseless , Paralysis , and Paraesthesia
X-ray: suggest high-risk fracture. Angiogram should be performed to confirm diagnosis.

This is an emergency because the effect of ischemia especially on the muscle is irrevesible after 6 hours.
1. Temporary vascular shunt to perfuse distal limb.
2. Skeletal stabilization – temporary external fixation often used.
3. Definitive vascular repair.
4. Staged definitive skeletal internal fixation if required.
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.
Compartment syndrome:
**Most commonly in forearm and calfs. **Muscles are arranged in different compartments and surrounded by one fascia , this arrangement called osteofascial compartment. **Compartment syndrome occurs when muscle swells within osteofacial compartment and occluds its blood supply >infarction and late ischemic contracture. **Trauma is the most common cause. reasons that lead to increase the pressure inside: 1. Bleeding 2. Edema 3. Infection

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