Early complications of fracture

Question 1

What are some early complications of fractures?

Answer 1

• Compartment syndrome
• Nerve damage
• Vascular injury
• Infection (from open fractures)
• Muscle damage and rhabdomyolysis
• Haemorrhage
• Fat embolism

Question 2

Describe compartment syndrome?

Answer 2

• Normally occurs due to inflammatory swelling of affected muscles
• Symptoms come on within hours

Question 3

What is the most important sign of compartment syndrome?

Answer 3

Pain on passive movement of muscle group involved

Question 4

Why are pulses often retained in compartment syndrome?

Answer 4

• Arterioles and nerve endings are more susceptible to effects of increased pressure
• Therefore necrosis is a result of small vessel compromise, while large arteries and nerves are still patent
• Pulselessness often only occurs in late stage when damage is irreversible`

Question 5

What are the signs of compartment syndrome?

Answer 5

• Pain on passive movement (most important)
• Compartment pressure difference of >30
• Raised CK
• 6P’s of ischaemia (pain, pallor, perishingly cold, paralysis, pulselessness, and parasthaesia (but not last 2 until too late))

Question 6

Which fractures are most at risk of compartment syndrome?

Answer 6

• Supracondylar
• Tibial shaft

Question 7

What 3 types of nerve injury occur as a result of fracture?

Answer 7

• Neuropraxia: temporary interruption of conduction from compression, will recover (most common)
• Axonotmesis: will recover but takes a long time
• Neurotmesis: won’t recover

Question 8

What are some common injuries and the associated nerve damaged?

Answer 8

• Shoulder dislocation: axillary nerve
• Humeral shaft: radial nerve
• Supracondylar fracture: anterior interosseus nerve from median nerve; associated with neuropraxia in kids
• Monteggia fracture: posterior interosseus nerve or radial nerve
• Distal radial fracture: median nerve
• Posterior hip dislocation: sciatic nerve (15%)
• Knee dislocation: common peroneal nerve

Question 9

What fractures are mostly associated with vascular injury?

Answer 9

High energy open fracture

Question 10

What are the signs of vascular injury?

Answer 10

• Extensive bleeding
• The 6P’s of ischaemia (pain, pallor, perishingly cold, paralysis, parasthaesia, pulselessness)

Question 11

What is the management of vascular injury in a fracture?

Answer 11

1) Reduction of fracture
2) Temporary vascular shunt
3) Definitive vascular repair