Late complications of facture

Question 1

What are some late onset complications of fractures?

Answer 1

• Non-union
• Malunion
• Post traumatic OA
• Avascular necrosis
• Myositis ossificans
• Growth disturbance
• Complex regional pain syndrome

Question 2

What is non-union of a fracture and what are the 2 types?

Answer 2

Failure of a fracture to heal
- May be hypertrophied, with a rounded, dense, sclerotic bone end
- May be atrophied, where the bone end is osteopaenic

Question 3

What are the 5 causes of non-union of fracture?

Answer 3

• 5I’s
• Ischaemia
• Infection
• Increased interfragmentary strain
• Interposition of tissue between fragments
• Intercurrent disease (e.g. malignancy or malnutrition)

Question 4

What is malunion of a fracture and how common is it?

Answer 4

• When a fracture heals in an imperfect position
• Relatively common, especially when reduction method is less invasive

Question 5

What are the consequences of malunion?

Answer 5

• Impaired function, deformity and discomfort
• Consequences not significant in humerus or clavicle

Question 6

What fractures is post-traumatic OA mainly associated with?

Answer 6

• Displaced intraarticular fractures
• Level of risk is proportional to degree of displacement

Question 7

When does avascular necrosis occur following fracture and give specific sites?

Answer 7

• Occurs when blood supply crosses the fracture plane and is disrupted causing bone death
• Often occurs in NOF, scaphoid and talus

Question 8

What are the sign/complications of AVN?

Answer 8

Pain, stiffness and OA

Question 9

How does AVN of the scaphoid occur?

Answer 9

• Scaphoid has retrograde blood supply (dorsal branch of radial artery enters distally and tracks back)
• Therefore mid scaphoid fracture causes proximal AVN

Question 10

Describe myositis ossificans?

Answer 10

• Ossification of muscle at site of haematoma
• Causes painful, restricted movement
• Commonly affects elbows and quadriceps
• Can be surgically excised