Complications of fractures

Question 1

What are the early local complications of fractures?

Answer 1

Vascular injury and distal necrosis
Skin necrosis
Nerve injury
Compartment syndrome

Question 2

What is a neurapraxia?

Answer 2

Temporary conduction block/demyelination

Question 3

Within how long should neurapraxia resolve?

Answer 3

28 days

Question 4

What is axonotmesis?

Answer 4

Axon dies distally from point of injury/wallerian degeneration

Question 5

Does axonotmesis recover?

Answer 5

Yes, slowly

Question 6

What is neurotmesis?

Answer 6

Complete transection of a nerve

Question 7

How common is neurotmesis with fracture or dislocation?

Answer 7

Rare

Question 8

Does neurotmesis recover?

Answer 8

Not without surgery

Question 9

When should a nerve injury be explored?

Answer 9

Open fracture
Neuralgic pain
Penetrating injury

Question 10

Why is neuralgic pain an indication for surgical exploration of a fracture?

Answer 10

Indicates ongoing compression

Question 11

What can be done if no nerve function returning?

Answer 11

Nerve conduction studies
Grafting
Tendon transfers

Question 12

What are the early systemic complications of a fracture?

Answer 12

Fat embolism
Hypovolaemia
Acute respiratory distress syndrome
Multi-organ dysfunction syndrome
Systemic inflammatory response syndrome

Question 13

What are the late local complications of a fracture?

Answer 13

Loss of function
DVT
Avascular necrosis
Osteomyelitis
Chronic regional pain syndrome
Post-traumatic arthritis
Non-union (atrophic, hypertrophic)
Malunion 
Volkmann's ischaemic contracture

Question 14

What are the symptoms of malunion?

Answer 14

Pain
Stiffness
Deformity
Loss of function

Question 15

Which fractures require x-rays to confirm healing?

Answer 15

Diaphyseal fractures of major long bones

Question 16

What are the signs of fracture healing?

Answer 16

Pain improved
No movement at site
No swelling or oedema
No tenderness

Question 17

What causes atrophic non-union?

Answer 17

Poor blood supply to the fracture site
Fracture gap too big 
Systemic disease
Smoking
Steroids, NSAIDs, biphosphonates

Question 18

What causes hypertrophic non-union?

Answer 18

Too much movement at the fracture site

Question 19

Does infection cause atrophic or hypertrophic non-union?

Answer 19

Both

Question 20

What causes volkmann’s ischaemic contracture?

Answer 20

Obstruction of brachial artery in forearm

Question 21

What is complex regional pain syndrome?

Answer 21

Exaggerated pain response due to injury

Question 22

What are the symptoms of complex regional pain syndrome?

Answer 22

Causalgia
Allodynia
Swelling
Skin changes

Question 23

How is complex regional pain syndrome treated?

Answer 23

Referral to pain specialist

Question 24

What is a late systemic complication of a fracture?

Answer 24

Pulmonary embolus