complications of fractures
TRANSCRIPT
![Page 1: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/1.jpg)
COMPLICATIONSOF
FRACTURES
![Page 2: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/2.jpg)
CLASSIFICATION
•Complications of fractures tend to beclassified according to whether theyare local or systemic and when theyoccur –
IMMEDIATE EARLY LATE
![Page 3: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/3.jpg)
IMMEDIATE HYPOVOLAEMIC SHOCK
Commonest cause of death following fractures
Cause- external/internal haemorrhage Treatment Iv crystalloids-ringer lactate,followed by
colloids and blood
![Page 4: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/4.jpg)
EARLY COMPLICATIONS
•Early complications occur at the timeof the fracture (immediate) or soonafter.
•They are again classified into- local Systemic •Early local complications tend to affect mainly the soft tissues
![Page 5: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/5.jpg)
LOCAL EARLY COMPLICATIONS
•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}
![Page 6: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/6.jpg)
•Wound Infection, more common for open
fractures •Tetanus
•Gas gangrene
•Injury to joints
![Page 7: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/7.jpg)
VASCULAR INJURY
![Page 8: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/8.jpg)
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
![Page 9: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/9.jpg)
![Page 10: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/10.jpg)
![Page 11: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/11.jpg)
VISCERAL INJURIES Commonly seen
in pelvic and rib fractures
![Page 12: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/12.jpg)
NERVE AND SKIN TISSUE DAMAGES
![Page 13: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/13.jpg)
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
![Page 14: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/14.jpg)
HAEMARTHROSIS
Bleeding in the joint because of fracture
![Page 15: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/15.jpg)
COMPARTMENT SYNDROME
•Fractures of the limbs can cause severeischaemia, even without damage to a major bloodvessel
•. Bleeding or oedema in an osteofascialcompartment increases pressure within thecompartment, reducing capillary flow and causingmuscle 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
![Page 16: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/16.jpg)
•Compartment syndromes can also result from ;
Crush injuries caused by falling debris orfrom a patient’s unconscious compressionof their own limb
Swelling of a limb inside an over tight cast
![Page 17: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/17.jpg)
•Compartment syndrome can occur in anycompartment, e.g. the hand, forearm,upper arm, abdomen, buttock, thigh, andleg.
•40% occur following fracture of the shaftof the tibia (with an incidence of 1-10%)and about 14% following fracture of aforearm bone.
•Risk is highest in those under 35 years
![Page 18: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/18.jpg)
•COMPARTMENTAL SYNDROME MAY LEADTO THE VOLKMANN'S ISCHAEMIA
![Page 19: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/19.jpg)
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 injury4.Redness, mottling and blisters
Watch for signs of renal failure{low-output uraemia with acidosis)
![Page 20: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/20.jpg)
![Page 21: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/21.jpg)
MANAGEMENT
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
![Page 22: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/22.jpg)
•Complications Acute renal failure secondary to rhabdomyolysis DIC Volkmann's contracture (where infarcted
muscle is replaced by inelastic fibroustissue)
![Page 23: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/23.jpg)
GAS GANGRENE
•Clostidium welchii ( perfringens )
•Clinical presentation Subcutaneous
crepitations Myonecrosis
•Treatment Debridement pencillin
![Page 24: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/24.jpg)
TETANUS
Causative agent
Clostidium tetani
TRISMUS DYSPHAGIA RISUS
SARDONICUS OPIS THOTONUS
Treatment
Bed rest and sedation
Immunoglobulin Respiratory
support pencillin
![Page 25: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/25.jpg)
SYSTEMIC EARLYCOMPLICATIONS
•Fat embolism•Shock•ARDS•Thromboembolism (pulmonary or venous)
•Exacerbation of underlying diseases such as diabetes or CAD Pneumonia Aspectic traumatic fever Septicemia Crush syndrome
![Page 26: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/26.jpg)
FAT EMBOLISM •This is a relatively uncommon disorder that occurs
in the first few days following trauma with amortality rate of 10-20%
•Fat drops are thought to be released mechanicallyfrom bone marrow following fracture, coalesce andform emboli in the pulmonary capillary beds andbrain, with a secondary inflammatory cascade andplatelet aggregation
•An alternative theory suggests that free fatty acidsare released as chylomicrons following hormonalchanges due to trauma or sepsis
![Page 27: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/27.jpg)
•Risk factors Closed fractures
Multiple fracturesPulmonary contusionLong bone/pelvis/rib fractures
![Page 28: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/28.jpg)
•PRESENTATION
•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
![Page 29: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/29.jpg)
![Page 30: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/30.jpg)
TREATMENT :-
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
![Page 31: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/31.jpg)
DEEP VEIN THROMBOSIS
Common complication associated with lower limb injuries and with spinal injuries •D.V.T. proximal to the knee
is a common cause of lifethreatening complication of pulmonary embolism
Causes Immobilization following trauma Fracture of legSymptomsLeg swellingCalf tenderness
![Page 32: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/32.jpg)
CONSEQUENCES:-
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
![Page 33: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/33.jpg)
ASEPTIC TRAUMATIC FEVER
•Aseptic traumatic fever: This issupposed to be due to absorption offibrin ferment taking place.
•It may, however, be due to someirritation, as of a badly fitting splint,and disappears on removal of it
![Page 34: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/34.jpg)
SEPTICAEMIA
•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
![Page 35: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/35.jpg)
MANAGEMENT
Initial Resuscitation - ABC 1.Secure airway 2. Support breathing 3.Restore circulation Fluid therapy Inotropic Support Antimicrobial therapy Respiratory Support
![Page 36: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/36.jpg)
CRUSH SYNDROME
•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
![Page 37: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/37.jpg)
LATE COMPLICATIONS
•Late complications are those which occurafter a substantial time has passed andare as a result of defective healingprocess or because of the treatment itself.
•They are again classified in to 2 groups Imperfect union of the fracture others
![Page 38: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/38.jpg)
OTHER LATE COMPLICATIONS
•Avascular necrosis•Shortening•Joint stiffness•Sudeck’s dystrophy•Osteomyelitis•Volkmann’s Ischaemic contracture•Myositis ossificans•Osteoarthritis
![Page 39: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/39.jpg)
IMPERFECT UNION OF THEFRACTURE
•They are again classified into four sub groups: Delayed union Non union Mal-union Cross-union
![Page 40: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/40.jpg)
DELAYED UNION
•When a fracture takes more than theusual time to unite, it is said to havegone in delayed union
•Causes: Inadequate blood supply infection Incorrect splintage 1.Insufficient splintage 2.excessive traction
![Page 41: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/41.jpg)
•Signs: The fractured site is usually tender The bone may appear to move in one piece,
if however, it is subjected to stress , pain isimmediately 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
![Page 42: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/42.jpg)
![Page 43: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/43.jpg)
•TREATMENT
Conservative: 1.Plaster should be sufficiently
extensive and must fit accurately
2.Replace traction by plaster splintage3.Use of functional bracing
Operative: Bone grafting with or without IF
![Page 44: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/44.jpg)
NON-UNION
•When the process of fracture healingcomes to a stand before itscompletion, the fracture is said tohave gone in non –union.
•It is not before six months that a fracture can be so labelled. Nonunion is one endpoint of delayed
union
![Page 45: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/45.jpg)
CAUSES :
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. Infection4. Pathological lesion
![Page 46: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/46.jpg)
PRESENTATION
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).
![Page 47: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/47.jpg)
![Page 48: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/48.jpg)
TREATMENT
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
![Page 49: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/49.jpg)
MAL-UNION
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
![Page 50: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/50.jpg)
. •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
![Page 51: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/51.jpg)
TREATMENT
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 byremodelling
Operative 1. Osteotomy 2.Excision of protruding bone 3. Osteoclasis 4.Redoing the fracture surgical
![Page 52: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/52.jpg)
AVASCULAR NECROSIS
•Blood supply of some bones is suchthat the vascularity of a part of it isseriously jeopardized followingfracture, resulting in necrosis of thepart.
![Page 53: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/53.jpg)
![Page 54: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/54.jpg)
CONSEQUENCES:-
Avascular necrosis causesdeformation of the bone. This leads, afew years later, to secondaryosteoarthritis and causes painfullimitation 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
![Page 55: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/55.jpg)
![Page 56: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/56.jpg)
•Treatment:- Avascular necrosis canbe prevented by early, energeticreduction of susceptible fracturesand dislocations. Treatment options:
1.Delay weight bearing till revascularization
to prevent collapse 2. Revascularization 3.Excision of the avascular segment 4.Total joint replacement
![Page 57: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/57.jpg)
SHORTENING
•It is a common complications of fractures and results from:- 1.Mal union of the long bones
2.Crushing: Actual bone loss3.Growth defects: growth plate or epiphyseal injuries
![Page 58: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/58.jpg)
TREATMENT:-
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
![Page 59: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/59.jpg)
![Page 60: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/60.jpg)
JOINT STIFFNESS
•It is a common complications of fracture treatment. •Shoulder, elbow and knee joints are
particularly prone to stiffnessfollowing immobilization
![Page 61: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/61.jpg)
CAUSES
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
![Page 62: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/62.jpg)
TREATMENT:-
Heat therapy and exercise Manipulation of the joint under
anesthesia Surgical interventions 1.To excise an extra articular bone block
2.To lengthen contracted muscles3.Joint replacement, if there is pain due tosecondary arthritis
![Page 63: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/63.jpg)
ALGODYSTROPHY/ SUDECK'S DYSTROPHY
•Also known as Reflex Sympathetic Dystrophy. •Involves a disturbance in the sympathetic nervous system. •Consequences:- pain Hyperaesthesia Tenderness Swelling
![Page 64: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/64.jpg)
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
![Page 65: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/65.jpg)
TREATMENT:-
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
![Page 66: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/66.jpg)
OSTEOMYELITIS
•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 mostcommon cause. Infection with afungus is a rare cause
![Page 67: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/67.jpg)
![Page 68: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/68.jpg)
TREATMENT:-
•After operative treatment of fracturebacteria may spread to the bone andmay 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
![Page 69: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/69.jpg)
VOLKMANN’S ISCHAEMICCONTRACTURE
•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 paralysismay happen
Clinical features:- Marked atrophy Flexion deformity Nails shows atrophic changes Skin becomes dry and scaly
![Page 70: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/70.jpg)
![Page 71: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/71.jpg)
TREATMENT:-
Mild deformity can be corrected by passivestretching using a turn-buckle splint(Volkmann's splint)
For moderate deformities, a soft tissue slidingoperation, where the flexor muscles arereleased from their origin, is performed
For a severe deformity, bone shortening operations may be required
![Page 72: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/72.jpg)
MYOSITIS OSSIFICANS
•Myositis ossificans is wherecalcifications and bony massesdevelop within muscle and can occuras a complication of fractures.
•It may also happens because of the ossification of the hematoma around a joint after a compound fractures
![Page 73: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/73.jpg)
![Page 74: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/74.jpg)
CLINICAL FEATURES:-
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
![Page 75: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/75.jpg)
In late stages Occupational and Physiotherapy is prescribed to regain movements Ultra sound In some cases surgical excision of
myositic mass is done
![Page 76: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/76.jpg)
OSTEOARTHRITIS
•Osteoarthritis is liable to followmalunion and traumatic injuries to thejoints.
•Joint surfaces become incongruent •Direction of stress transmission is abnormal •Increase wear and tear at the joint
![Page 77: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/77.jpg)
![Page 78: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/78.jpg)
TREATMENT:-
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, and3.slow the progression of the disease
Anti-Inflammatory Medications
![Page 79: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/79.jpg)
Cortisone Injections Occupational and physiotherapy Weight Loss Activity Modification Diet: obesity is a risk factor for
developing osteoarthritis
![Page 80: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/80.jpg)
IATROGENIC COMPLICATIONS
Casts
Pressure ulcers Thermal burns during plaster hardening Thrombophlebitis
![Page 81: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/81.jpg)
TRACTION
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
![Page 82: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/82.jpg)
EXTERNAL FIXATION
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
![Page 83: Complications of fractures](https://reader034.vdocuments.us/reader034/viewer/2022052307/556ca3a6d8b42a44468b4d85/html5/thumbnails/83.jpg)
THANK YOU