early complications of fracture slideshare
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Fractures are associated with a range of potential complications. Septic shock. Impossible. types of fractures:. delayed uniounnon unionmalunion avascular necrosisosteoarthiritisshortening. Nerve injury. of fractures, narayan shree homeopathic medical college, Tibia and fibula diaphysis, ankle and foot injuries, Lecture ucmc pilon plafond fracture distal tibia, ortho 03 principle of closed reduction in fracture and dislocation, Orthopedics 5th year, 9th lecture (Dr. Ali A.Nabi), Rhinology - The New EPOS Guidelines for CRS - Prof Valerie Lund.pdf, Pathology of common ocular and orbital tumors, International Information Resource Centre, First dose size in humans and non linear pharmacokinetics.pptx, Anatomy of Vertebral column for physioterapy (4).ppt, holiday assignment science covid ppt.pptx, Rethinking nicotine: illusions, delusions and some conclusions, PNS- radiological anatomy (wecompress.com) (1).pptx, No public clipboards found for this slide. * Even if its outward appearance is normal, the intima may be detached and the vessel blocked by thrombus, or a segment of artery may be in spasm. 1. The appearances suggest that , although the fracture has not united, it eventually will. Stable hypermetabolism (systemic inflammatory response). Others are unavoidable but their resolution may be aided by early diagnosis and appropriate treatment. 5 Simple Knee Injury Prevention Exercises. GAS GANGRENE Produced by anaerobic orgs : Clostridium sp infections. Hip fractures, particularly in elderly patients, lead to loss of mobility which may result in pneumonia, thromboembolic disease or rhabdomyolysis. Nerve damage may result in motor and sensory loss. Humeral supracondylar fracture (brachial artery). Hip fractures are among the most common orthopaedic injuries sustained by elderly patients. delayed union and nonunion avascular necrosis of bone reaction . 1- VISCERAL INJURY Fractures around the trunk are often complicated by injuries to underlying viscera, the most important being 1- penetration of the lung with life-threatening pneumothorax following rib . COMPLICATIONS OF FRACTURES. feinstein october 2009. simple. 5. Done by: S elena abboud Rand A lshayeb Rahaf H asanain. The features at this stage are essentially those of ARDS. 3- Fat embolism. In the lower limb, shortening of more than 2.0 cm is. delayed union non-union malunion joint stiffness myoisitis ossificans avascular. *The patients expectations (often prompted by cosmesis) may be quite different from the surgeons; they are not to be ignored. *These injuries require emergency treatment. 13. bld flow coz Ischemia leads to tissue death & peripheral gangrene. Immobilization (whether by cast or by internal fixation) should be sufficient to prevent shear at the fracture site, but fracture loading is an important stimulus to union and can be enhanced by: (1) encouraging muscular exercise and (2) by weightbearingin the cast or brace ?. Complaints of numbness or paraesthesia in the distribution of the median or ulnar nerves should be taken seriously and the patient monitored ; if there is no improvement within 48 hours of fracture reduction or splitting of bandages around the splint, nerve should be explored and decompressed, Compartment Syndrome Fractures of the arm or leg can cause ischaemia, even if there is no damage to a major vessel. closed. -The nerve should be explored at the time of debridement and repaired at the time or at wound closure. Bed sore. A differential pressure (P) the difference between diastolic pressure and compartment pressure of less than 30 mmHg is an indication for immediate compartment decompression A split/ wick catheter. Acute complications occur as a direct result of the trauma sustained and can include damage to vascular structures, nerves, or soft tissue. However, the bone ends are notsclerosed nor atrophic. x-rays of fractures for salter harris, Fractures - . It is only because the fixation device holds the fragments so securely that the fracture seems to be uniting. Complications of fractures fall into two categories: early and delayed. Clinical features :- Avascular necrosis causes : intractable non union , disabling osteoarthritis or total disorganization of a joint . Complications of fractures Types Early - General - Local Late - General - Local Early general *The effects vary -transient diminution of blood flow -profound ischaemia -tissue death -peripheral gangrene. Gas gangrene. (c) gradual collapse of comminuted bone . 7- Thrombo-embolism. high urine flow is encouraged with alkalization of the urine with sodium bicarbonate, prevents myoglobin precipitating in the renal tubules. Delayed complications may occur after initial treatment or in response to treatment. Clinical features :- Movement can be elicited at the fracture site and pain diminishes ; the fracture gap ( cavity between the bone ends ) becomes a type of pseudoarthrosis. EARLY COMPLICATION Local Visceral Injury Vascular Injury Nerve Injury Compartment Syndrome Haemarthrosis Infection Gas gangrene, LOCAL VISCERAL INJURY Fracture around the trunk are often Cx by injury to the adjacent viscera : Pelvic fracture Bladder and urethral rupture Rib fracture penetration to the lungs Pneumothorax, VASCULAR INJURY Most commonly knee, femoral shaft, elbow, and humerus. outlines. Excision of dead muscle must be radical to avoid sepsis. Both occur during limb swelling and are due to elevation of the epidermal layer of skin from the dermis . spiral fracture. NONUNION OF FRACTURES - Introduction:. clinically: - should be tested by stretching the muscles when the toes or fingers are passively hyperextended there is pain in the calf or forearm. 4. As a general rule , union is deemed to be delayed if the fracture is still freely mobile after 3 or 4 months . 2- Biomechanical cause :- A-Imperfect splintage. Common vascular injuries may associate with the following fractures. Multiple organs failure syndrome (MOFS). (7) non-compliance on the part of the patient . Growth disturbance. 4- Severe cases: respiratory distress and coma, due to brain emboli and hypoxia from involvement of the lungs. Pelvic fracture (presacral and internal iliac). fractures of teeth. Loss of initial reduction or fixation spiral fracture. . Introduction. 2- Operative :- More often , non-union of a fracture is disabling and surgical treatment is desirable , With hypertrophic non-union and in the absence of deformity, very rigid fixation alone (internal or external) may lead to union. These include vascular damage such as disruption to the femoral artery or its major branches by femoral fracture, damage to the pelvic arteries by pelvic fracture. Acute long bone fractures primarily result from significant trauma. Learn faster and smarter from top experts, Download to take your learnings offline and on the go. Management involves delay in surgical intervention and casting. X-ray shows the characteristic increase in x-ray density , which occurs as a consequence of two factors: (a) disuse osteoporosis in the surrounding parts gives the impression of increased density in the necrotic segment, and (b) collapse of trabeculae compacts the bone and increases its density. until the total vascularity of the muscles and nerves is jeopardized. In closed injuries nerve is seldom severed and spontaneous recovery should be awaited. . Post-traumatic wound infx is most common cause of chronic osteomyelitis union will be slow and chance of refracturing. 1- Biological cause :- A-Inadequate blood supply A badly displaced fracture of along bone will cause tearing of both the periosteum and interruption of the intramedullary blood supply . Peripheral nerve injuries occur in 5-15% of supracondylar fractures. Thrombo-embolism. Late complications of fractures - Outlines. Fracture blisters. A complication of shoulder fracture or . Early: 1. 2. description. Lateral Patellar Instability | MPFL Repair | Patellar Knee Injuries. if the clinical signs are soft, the limb should be examined at 30-minute intervals and if there is no improvement within 2 hours of splitting the dressings, fasciotomy should be performed. Local . (within 12 hours) The necrotic muscle undergo healing with fibrosis, leading to Volkmanns contracture. *Clinical features Early warning signs of fat embolism (usually within 72 hours of injury) are 1- slight rise of temperature and pulse rate. Period of active resuscitation. 11. C- Periosteal stripping over-enthusiastic stripping of periosteum during internal fixation is an avoidable cause of delayed union . 5% of long bone fractures will result in nonunion and even more in delayed union. Fat embolism. 2. Fasciotomy is performed. This contrasting appearance has led to non-union being divided into hypertrophic and atrophic types. bone breaks cleanly but does not penetrate the skin. Late. Skin necrosis 2. Life-threatening complications. a bone fracture (sometimes abbreviated, Types of Fractures - . Activate your 30 day free trialto unlock unlimited reading. Shock fat embolism compartment syndrome deep vein thrombosis thromboembolism (pulmonary embolism) disseminated intravascular coagulopathy, and infection. bone breaks cleanly but does not penetrate the skin. INFECTION Causes: Open fracture (common) Use of operative method in the Tx of # Wound becomes inflamed and starts draining seropurulent fluid. The SlideShare family just got bigger. Injuries to adjacent structures. The bone ends are rounded with no suggestion of new bone formation. Gas gangrene---characterized by myonecrosis, There are, of course, also biological and patient-related, 3. Shock (hypoperfusion). In hypertrophic non-union the bone ends are enlarged, suggesting that osteogenesis is still active but not quite capable of bridging the gap. Silver sulfadiazine seemed in one review to promote re-epithelialisation. (d) osteoporotic bone . Bleeding, oedema or inflammation (infection) may increase the pressure within one of the osseofascial compartments- reduced capillary flow- muscle ischaemia oedema- greater pressure - more profound ischaemia swelling of a limb inside a tight plaster cast. Treatment :- CONSERVATIVE or OPERATIVE 1- Conservative :- Non-union is occasionally symptomless, needing no treatment as it might cause slight instability and is best left untreated ,or at most, (a) a removable splint. The most difficult recovery happens in this type of fracture. 12. Knee dislocation (Popliteal artery). Growth defects: growth plate or epiphyseal injuries. 5. with the end of the lecture. 4- Pulmonary embolism. Delayed union. FRACTURES
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. 1- Blood loss 2- Shock *Hypovolemic or hemorrhagic shock. 1. Arterial. Gas gangrene 4. CLINICAL DIAGNOSIS OF FRACTURE AND GENERAL PRINCIPLE OF MANAGEMENT OF FRACTURE, Dr. Vitthalrao Vikhe Patil Foundation's College of Physiotherapy, Ahmednagar, Fractures, bone healing & principles of tx. This result in ischaemic muscle necrosis and nerve damage. 15-3 ). (e.g. fall 2011. risk factors. Fracture complications include: Acute. - Very little is known of the long-term effects of small angular deformities on joint function . 6. C-Infection. mohammad ararawi. classification of fractures. Shortening It is a common complications of fractures and results from:1. introduction. ABG and Urinalysis There is no test for fat embolism Management -supportive -oxygen -stabilization of long-bone fractures -analgesia -corticosteroids for severe multiple injuries(methylpredinosolone to maintain oxygen tension) -heparin or dextran ( improve capillary flow), Crush syndrome when a limb is compressed for extended periods underperfusion - myonecrosis - release of toxic metabolites reperfusion injury - Membrane damage and capillary fluid reabsorption failure swelling - may lead to compartment syndrome - more tissue damage from ischaemia. . age under 17 over 35 gravida and parity socioeconomic, Complications of Pregnancy - . These are a relatively uncommon complication of fractures (2.9% of fractures admitted to hospital in one series) in areas where skin adheres tightly to bone with little intervening soft tissue cushioning. Local . Certain body sites are more common for nonunion because of poor blood supply including the fifth metatarsal, tibia, hamate and scaphoid bones. 6. Failure to recognize the difference may lead to unnecessary amputation for the non-lethal cellulitis, swelling around the wound, brownish discharge gas formation, Prevention Deep, penetrating wounds in muscular tissue are dangerous; they should be explored, all dead tissue should be completely excised and, if there is the slightest doubt about tissue viability, the wound should be left open. Typically, after a broken bone, imaging is ordered to see if the broken limbs are displaced. Examples include the ankle, wrist, elbow and foot. The SlideShare family just got bigger. 2- breathlessness ,mental confusion ,restlessness. Fractures are common: most people will experience at least one during a lifetime. Tendon lesions. Description: Is an area of the body encased by bone or fascia . fall 2011. risk factors. description. dr. abdulrahman algarni , md, ssc (ortho), abos assist. 8. outlines. 2- Operative :- each case should be treated on its merits; however, if union is delayed for more than 6 months and there is no sign of callus formation, internal fixation and bone grafting are indicated. HAEMARTHROSIS Fractures involve joints, leads to acc. Neurogenic shock. Crush syndrome. (Actually this is an early complication however the clinical and radiological effects are not seen until weeks or even months)<br />No clinical feature of avascular necrosis but if there is a failure to unite or bone collapse-pain<br /> . three main categories. Tetanus. With atrophic non-union, fixation alone is not enough. Two basic pathologic processes may result from supracondylar fractures or other injuries to the elbow region that can lead to forearm ischemia: (1) arterial injury and (2) compartment syndrome from hemorrhage or postischemic swelling ( Fig. In advanced cases, amputation may be essential, Fracture blisters Two distinct blister types are seen after fractures: clear fluid-filled vesicles and blood-stained ones. (c) Pulsed electromagnetic fields and low-frequency, pulsed ultrasoundcan also be used to stimulate union . Complications of fractures Done by: Selena abboud Rand Alshayeb RahafHasanain, COMPLICATIONS OF FRACTURES General Local Early Late. Now customize the name of a clipboard to store your clips. (5) infection (particularly osteomyelitis ) . Revascularization 3.Excision of the avascular segment 4.Total joint replacement. Union by primary bone healing is slow, but provided stability is maintained throughout, it does eventually occur. Rotational deformity of a metacarpal fracture is detected by asking the patient to flatten the fingers onto the palm and seeing whether the normal regular fan-shaped appearance is reproduced . * The artery may be cut, torn, compressed or contused either by the initial injury or subsequently by jagged bone fragments. 3- Patient related :- There are patients who are :- Immovable. A window must immediately be cut in the plaster, or warning pain quickly abates and skin necrosis proceeds unnoticed. COMPLICATIONS OF FRACTURES. An arterial injury may result from laceration, thrombus, embolus, intimal tear, or pseudoaneurysm . Fractures are associated with a range of potential complications. 5- Crush syndrome. 9. Nerve is capable of regeneration but muscle, once infarcted, can never recover and is replaced by inelastic fibrous tissue (Volkmanns ischaemic contracture). 4. ( algodystrophy). It appears that you have an ad-blocker running. Patients who are treated surgically, but fail acutely face a more complex operat classification of fractures. Hg is an indication of compartment decompression and fasciotomy. a- immediate or operative complications. fractures of alveolar, The earliest of the classic features are pain (. Fat embolism Circulating fat globules occlude small blood vessels, occur after closed fractures of long bones and traces of fat can be found in the lungs and other internal organs. In the last two decades there have been major changes in the management of lower limb long bone fractures, where resources permit, surgical management of open . - PowerPoint PPT presentation. Wound becomes inflamed and starts draining seropurulent fluid. Delayed complications include delayed union and nonunion, avascular necrosis of bone . A retrospective study using the UK GP Research Database identified the main risk factors for healing complications (delayed union, non-union or malunion), regardless of fracture site, as: The process of normal fracture healing involves: For healing to happen the site needs adequate stability, a blood supply and adequate nutrition. 4. OPEN FRACTURES COMPLICATIONS: OSTEOMYELITIS, RAD 422 Fractures Types, Complications, and management - . Complications of fractures. Causes are (a) failure to reduce a fracture adequately . Post-traumatic wound infection is now the most common cause of chronic osteitis. may lead to irreversible damage of the life supporting organs.Thirst, rapid shallow breathing, the lips and skin are pale and the extremities feel cold,if the compansation fails.. impaired renal function test and decreased urinary output. Infection. Nerve Trauma Effect Axillary Dislocation of shoulder # of humerus Deltoid paralysis Pointing index Sciatic Supracondylar # of humerus # medial epicondyl humerus Post dislocation of hip Common peroneal Knee dislocation # neck of fibula Foot drop Radial Median Ulnar Wrist drop Claw hand Foot drop. a disruption or break in the continuity of the structure of bone traumatic injuries account, FRACTURES - . A rise in pressure within these compartments may jeopardize the blood supply to the muscles & nerves within the compartment. A recent motor vehicle accident (one month or less prior to fracture). Infection may be superficial, moderate (osteomyelitis), severe (gas gangrene). delayed unioun non, Complications of Supracondylar Fractures - . Compartment syndrome. Enjoy access to millions of ebooks . Tap here to review the details. 1- Blood loss 2- Shock *Hypovolemic or hemorrhagic shock. Stability Was the fracture held with sufficient stability? Gas gangrene. a disruption or break in the continuity of the structure of bone traumatic injuries account, FRACTURES - . careless selection of ring size, excessive fixed traction, and neglect can lead to pressure sores around the groin and iliac crest, Late complications 1-DELAYED UNION 2-NON-UNION 3-MALUNION 4-AVASCULAR NECROSIS 5-GROWTH DISTURBANCE 6-BED SORES 7-MYOSITIS OSSIFICANS 8-TENDON LESIONS 9-NERVE COMPRESSION 10-MUSCLE CONTRACTURE 11-JOINT INSTABILITY 12-JOINT STIFFNESS 13-COMPLEX REGIONAL PAIN SYNDROME (ALGODYSTROPHY) 14-OSTEOARTHRITIS, DELAYED UNION If the time in which a fracture may be expected to unite and consolidateis prolonged, the term delayed union is used .It must never be relied upon in deciding when treatment may be discontinued . of ulna and radius. General complications. For the purposes of this topic, long bones are defined as the humerus, radius, ulna, femur, tibia, and fibula.Acute fractures usually have a dramatic presentation, whereas stress fractures often present more subtly.Acute fractures i . Click here to review the details. 3. This is particularly important during the first 3 weeks, when the situation may change without warning. The causes of circulatory shock can be classified as abnormalities of cardiac output, of systemic vascular resistance, or a combination of both HYPOVOLAEMIC SHOCK: Reduced circulating volume causing a reduction in venous return and cardiac output (e.g.haemorrhage) Neurogenic shock : when spinal cord injury at a cervical or high thoracic level leads to loss of sympathetic tone and peripheral vasodilatation, venous pooling and reduced venous return. Early complications include shock, fat embolism, compartment syndrome, deep vein thrombosis, thromboembolism ( pulmonary embolism ), disseminated intravascular coagulopathy, and infection. - Early discussion with the patient, and a guided view of the x-rays, will help in deciding the need for treatment and may prevent later misunderstanding. Complications of Diabetes, Diabetes Complications, Long-term complications of diabetes, major complications of - Do, Principles of fractures - . Proximal tibia (popliteal or its branches). (b) failure to hold reduction while healing proceeds . Patient complains from : - intense pain - swelling around the wound - brownish discharge - gas formation - little or no pyrexia - characteristic smelling - toxaemic coma death the prime site for infection is a dirty wound with dead muscle that has been closed without adequate debridement, Gas gangrene---characterized by myonecrosis Anaerobic cellulitis in which superficial gas formation is abundant but toxaemia usually is slight. This article highlights 2 important complications of fracture: acute compartment syndrome and fat embolism syndrome (FES). COMPARTMENT SYNDROME Definition Compartment syndrome involves the compression of nerves and blood vessels within an enclosed space, leading to impaired blood flow and nerve damage. Fracture complications are often variably defined, and there is a lack of consensus in their assessment, which makes their incidence difficult to estimate. COMPLICATION OF FRACTURE General Local Early Late. NERVE INJURY Variable degree of motor and sensory loss along the distribution of the nerve May be neurapraxia, axonotmesis or neurotmesis Radial nerve is most frequently damaged nerves. Shock; hemorrhagic, neurogenic or septic, Complications of Fractures: 1-General complications: shock..etc 2-Local complications: Early Late, General complications Shock; hemorrhagic, neurogenic or septic Crush syndrome: fracture muscle damage acid myoglobin release in the circulation precipitate in renal tubules and vasoconstriction of renal arteries renal tubular necrosis and failure DVT, PE and FPE Fat embolism Tetanus and gas gangrene ARDS, Local complications Early: Visceral injuries Vascular injuries Nerve injuries; neuropraxia, axonotomesis, neurotomesis Compartment syndrome Haemarthrosis infection, Local complications Late: Delayed union, Causes Inadequate blood supply Severe soft-tissue damage Periosteal striping Movement at fracture site Imperfect splinting Infection, Local complications Non-union, either hypertrophic or atrophic CAUSES Excusive soft-tissue loss/damage Bone loss Intact fellow bone Soft-tissue interposition Poor blood supply Poor haematoma formation Infection Pathological fracture Poor splintage or fixation Impatience Patient- immence, immpatient, impossible, immovable, Local complications Malunion, either angulation, rotation or shortening Avascular necrosis osteoarthritis pain Growth disturbance Bed and cast sores Myositis ossificans, heterotophic ossification Rupture of tendons Nerve compression by callus, or streching by deformity Muscle contracture Jiont instability from lig., bone or mm weakness Joint stiffness, extra-, peri-, or intra-articular cause Allgodystrophy (complex regional pain syndrome) Sudecks atrophy Osteoarthrosis joint degeneration, 2022 SlideServe | Powered By DigitalOfficePro, - - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -. Damage to surrounding tissue, nerves or skin. Antibiotics are needed, while the wound has to be tendered by a surgeon. NON-UNION In a minority of cases delayed union gradually turns into non-union that is it becomes apparent that the fracture will never unite without intervention. 3- Pathognomonic signs are petechiae on the trunk, neck, axillae and conjunctiva. hemothorax occur from displaced clavicular fracture. ? introduction. If there is muscle necrosis debridement If muscle is healthy suture (w/o tension)/ skin grafted / simply heal by 2 intention. Treatment :- CONSERVATIVE or OPERATIVE 1- conservative : The two important principles are: (1) to eliminate any possible cause of delayed union and (2) to promote healing by providing the most appropriate environment. Complications of Fractures: - . Mal union of the long bones 2. Exacerbation of underlying diseases such as diabetes or coronary artery disease (CAD). It is a common complications of fractures and results from:- 1.Mal union of the long bones 2.Crushing: Actual bone loss 3.Growth defects: growth plate or epiphyseal injuries. Contact Was there sufficient contact between the fragments? MALUNION When the fragments join in an unsatisfactory position (unacceptable angulation, rotation or shortening) the fracture is said to be malunited. objectives. Outcome of surgically treated acetabular fractures: risk factors for postoperative complications and for early conversion to total hip arthroplasty Many fac-tors influence the speed with which fractures heal (Chart 69-3). A few guidelines are offered:- 1. Treatment: Shortening of upper limbs goes unnoticed For lower limb treatment depends upon the amount of shortening:1. Complications of fractures. -Skin sensation repeatedly checked- Ischaemic muscle is highly sensitive to stretch. Early. 2022 SlideServe | Powered By DigitalOfficePro, - - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -. Early complications. Skin loss is present and extensive, muscles are severely damaged, tendons and other tissues are also affected. Acute complications occur as a direct result of the trauma sustained and can include damage to vascular structures, nerves, or soft tissue. medical ppt. Certain regions are known for their propensity to develop ischaemia and bone necrosis after injury . professor consultant orthopedic and, FRACTURES - . Infection may be superficial, moderate (osteomyelitis), severe (gas gangrene). orbital (60-75%) intracranial (15-20%) bony (5-10% ) radiography. -spontaneous recovery awaited occurs in 90% within 4 months. Get powerful tools for managing your contents. Late 1. 3. Therefore, reevaluation at regular intervals during . Vascular injury * The fractures most often associated with damage to a major artery are those around the knee and elbow, and those of the humeral and femoral shafts. 7. Version 2.0 Fracture Complications 19/05/2012 Early complications Local: 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 (or Volkmann's ischaemia) 3 MOBILITY AT THE FRACTURE SITE Excessive mobility persisting at the fracture site (due, for example, to poor fixation) may interfere with vascularisation of the fracture haematoma; it may lead to disruption of early bridging callus and may prevent endosteal new bone growth.. "/> Haemoarthrosis. Fracture complications such as excessive bleeding or soft tissue compromise, infection , neurovascular injury, presence of complex bone injury, such as crushing or splintering, and severe soft tissue trauma will clearly prolong and possibly hinder or prevent this healing process. general, Late complications of fractures - . - Casts, bandages and dressings must be completely removed. However, fractures are associated with a range of complications. Activate your 30 day free trialto continue reading. (( no open wound and compartment pressures are not high,risk of infection is lower if early surgery is avoided)), Multiple organ failure syndrome (MODS) is the clinical appearance of a poorly controlled severe systemic inflammatory reaction, following a triggering event such as infection,inflammationor trauma. (3) poor soft tissues (from either the injury or surgery) . Organ failure Management: Prevention, remove risk factors, oxygen,treat underlying cause, Local complications - Early Visceral injury Vascular injury. This is a tabulated compilation for complications of fractures in general which can be immediate, early or delayed and local or generalized/systemic. mohammad ararawi. -The P monitored; if it falls below 30 mmHg, immediate open fasciotomy is performed. Introduction Distal radius fractures are the commonest fractures presenting to Orthopaedic trauma surgeons As populations continue to age, and their activity levels increase, the incidence of distal radius fractures is expected to rise. frango, 3. fregi, fractum to break, Complications of Pregnancy - . Medications may impair healing of fractures. Fracture blisters 3. Other adverse effects especially of skeletal traction include complications of sepsis at the pin site, pulmonary complications and knee stiffness because of the prolonged immobilization. However, it seems likely that malalignment of more than 15 degrees in any plane may cause asymmetrical loading of the joint above or below and the late development of secondary osteoarthritis; this applies particularly to the large weightbearingjoints. delayed unioun non, Complications of Supracondylar Fractures - . *Septic shock. Gas gangrene. 3. The median nerve is most at risk with . a vicious circle that ends after 12 hours or less, in necrosis of nerve and muscle within the compartment. Late. Instant access to millions of ebooks, audiobooks, magazines, podcasts and more. On x-ray, the fracture line remains visible and there is very little or incomplete callus formation or periosteal reaction. View 2.Complications of Fractures.pdf from SDGSG 6474 at Jordan University of Science & Tech. Compartment syndrome. By whitelisting SlideShare on your ad-blocker, you are supporting our community of content creators. In the case of the leg, fasciotomy means opening all four compartments through medial and lateral incisions. Fat embolism. Fracture : Diagnosis, Complications and Prevention. 1) rib fractures : pneumothorax - penetration of the lung Spleen trauma Liver injury 2) pelvic fractures - rupture of the bladder or urethra. Done by: S elena abboud Rand A lshayeb Rahaf H asanain. Crushing: Actual bone loss 3. professor consultant orthopedic and, FRACTURES - . It is important to set bones properly to avoid malunion. Fasciotomy Compartment pressure, A vicious cycle cont. Create stunning presentation online in just 3 steps. Fracture blisters form over the fracture site and alter management and repair, often necessitating early cast removal and immobilisation by bed rest with limb elevation. Delayed complications may occur after initial treatment or in response to treatment. General complications Shock Hypovolemic or hemorrhagic shock. visceral Injury * Fractures around the trunk are often complicated by injuries to underlying viscera. Complications clearly vary with fracture site and nature and with quality of surgery but many also vary with patient attributes such as age, nutritional status, smoking status and alcohol use. Infection Open fractures may become infected; closed fractures hardly ever do unless they are opened by operation. lecture .4. l earning objectives. Hip fractures, particularly in elderly patients . Rotational deformity of the femur, tibia, humerusor forearm may be missed unless the limb is compared with its opposite fellow. Femoral supracondylar fracture (Femoral artery). 1-general complications: shock..etc 2-local complications: early late. General complications Shock Hypovolemic or hemorrhagic shock. OPEN FRACTURES COMPLICATIONS: OSTEOMYELITIS, RAD 422 Fractures Types, Complications, and management - . High-risk injuries are fractures of the 1- elbow 2- forearm bones 3- proximal third of the tibia 4- multiple fractures of the hand or foot 5- crush injuries and circumferential burns. -by agent causing fracture Acute nerve compression -Distinct from a direct injury, with fractures or dislocations around the wrist. Dopamine (1-20g/kg/min)Dobutamine (1-20g/kg/min)Adrenaline (1-20g/min)Noradrenaline (1-20g/min), Its a re-perfusion injury seen after the release of crushing pressure, there will be release of muscular breakdown products(myoglobin,k+,p) which have nephrotoxic effect on the kidneyFirst describe by Eric Bywaters, 4C Colour blue-black purpleConsistency MushyContractibility unableCut not capable to bleedDeep, penetrating wound in muscular tissue should be explored, ALL DEAD TISSUE SHOULD BE COMPLETELY EXCISED, if there is doubt about tissue viability, the wound should be left opened, Neuropraxia = misspellingNeurapraxia = neuro + a [no] + praxia [action]Axonotmesis = axon + tmesis [cut]Neurotmesis = Nerve + tmesis [cut]. C/Feature : The joint is swollen and tense and patient will resists any movement. Smoking . In the lower limb, shortening of more than 2.0 cm is seldom acceptable to the patient and a limb length equalizing procedure may be indicated. Haemarthrosis Fractures involving a joint, leads to accumulation of blood. Enter your email address to subscribe to this blog and receive notifications of new posts by email. Learning Point. (( open wound then this should be managed)) . Have u ever tried external professional writing services like www.HelpWriting.net ? InjuryVessel First rib fracture/clavicle Subclavian artery Shoulder dislocation Axillary artery Humeral supracondylar fracture Brachial artery Elbow dislocation Brachial artery Pelvic fracture Presacral and internal iliac artery Femoral supracondylar fracture Femoral artery Knee dislocation Popliteal artery Proximal tibial Popliteal artery or its branches Temporal/ parietal middle meningeal artery, Clinical features - paraesthesia or numbness in the toes or the fingers. Patients with multiple rib fractures may develop pneumothorax, flail chest and respiratory compromise. Associated systemic illness . If the zone of necrosis is extensive, as might occur in highly comminuted fractures, union may be interrupted . The fracture edges will become necrotic and dependent on the formation of an ensheathingcallus mass to bridge the break. Compartment syndrome 6. spring 2012. risk factors. In atrophic non-union, osteogenesis seems to have ceased. COMPLICATION OF FRACTURE General Local Early Late. lecture .4. l earning objectives. http://hastaneciyiz.blogspot.com. - In more advanced cases, there may be decreased sensation, weakness, and, Injuries with a high risk of developing Compartments synd: # of the elbow # of the forearm bone # of the proximal third of the tibia, THE VICIOUS CYCLE OF VOLKMANNS ISCHAEMIA Arterial ischaemia blood flow 5 Ps Pain Damage Pallor Paraesthesia Pulseless Paralysis Direct injury oedema . Presentation Transcript. EARLY COMPLICATIONS Early complications may present as 1- part of the primary injury or 2- may appear only after a few days or weeks. One of the most serious and most common complications of a bone fracture is called malunion. General . Osteoarthritis. [2], Risk factors, other than site, include any condition which predisposes to poor skin healing, including diabetes, hypertension, smoking, alcohol excess and peripheral vascular disease.[3]. type causes investigation symptoms, Fractures - . the classical form of MODS appears to progress through four clinical phases: 1. Treatment :- Incipient malunion may call for treatment even before the fracture has fully united; the decision on the need for re-manipulation or correction may be extremely difficult. - By sharp edge of a bone Open nerve injuries -Nerve injury is more likely to be complete. The risk of complications varies with the particular fracture, its site, circumstances and complexity, with the quality of management, with patient-specific risk factors such as age and comorbidities, and with post-fracture activities such as air travel and immobility. frango, 3. fregi, fractum to break, Complications of Pregnancy - . objectives. Haemoarthrosis. With modern medical and surgical care most heal without problems or significant loss of function. These organisms can survive and multiply in O2 tension Toxins produced will destroy the cell wall and leads to tissue necrosis Clinical features: within 24hr. B-Over-rigid fixation. 6- Multiple organs failure syndrome (MOFS). (features) The joint is swollen and tense and the patient resists any attempt at moving it. Hip fracture in older patients leads to high morbidity and mortality. NONUNION OF FRACTURES - Introduction:. dr. abdulrahman algarni , md, ssc (ortho), abos assist. Age . Nerve damage may result in motor and sensory loss. 2. by encouraging weightbearing). Nerve injury. The compromised limb is pulseless,red, swollen,blistered; sensation and muscle power may be lost. Malunion. Principles of Fractures - . Aim: To analyze the early complications associated with preoperative external traction fixation in the staged treatment of tibial fractures. Hard callus formation as new bone bridges the fracture site. Stimulation Was the fracture sufficiently stimulated? We've updated our privacy policy. Visceral injury (the lung, the bladder, the urethra, and the rectum). There are no symptoms associated with avascular necrosis, but if the fracture fails to unite or if the bone collapses the patient may complain of pain. 8. Confirmation of the diagnosis is by measuring the intra compartmental pressures. The watchword is patience; however ,there comes a point with every fracture where the ill-effects of prolonged immobilization outweigh the advantages of non-operative treatment. fractures of alveolar, Complications of Sinusitis - . Both biology and stability are affected by active infection: not only is there bone lysis, necrosis and pus formation, but implants which are used to hold the fracture tend to loosen. If compartment syndrome develops, and is confirmed by pressure measurements, then a fasciotomy is indicated. Enjoy access to millions of ebooks, audiobooks, magazines, and more from Scribd. Late complications of fractures - . If no recovery by the expected time, and if nerve conduction studies fail to show evidence of recovery, the nerve should be explored. Thrombo-embolism. 2 Categories of Fracture Complications. . Looks like youve clipped this slide to already. The wound should be left open and inspected 2 days later. Myositis ossificans. age under 17 over 35 gravida and parity socioeconomic, Complications of Pregnancy - . what's fracture of ulna and radius? In the forearm and leg a single-bone fracture may be held apart by an intact fellow bone. *Management -ABC -Oxygen -fluids -Inotropes/vasopressors: if the patient remains hypotensive despite adequate fluid resuscitation -systemic support for other organs. (6) associated drug abuse, anti-inflammatory or cytotoxic immunosuppressant medication . Excessive traction (creating a fracture gap) or excessive movement at the fracture site will delay ossification in the callus. , Treatment: Antibiotic Excising all devitalised tissue If Sx of acute infx and pus formation : tissue around the fracture should be opened & drained. 5. Therefore, reevaluation at regular intervals during . 6. -The limb should be nursed flat (elevating the limb causes a further decrease in end capillary pressure and aggravates the muscle ischaemia). 2. Use of non-steroidal anti-inflammatory drugs (NSAIDs) within 12 months. By accepting, you agree to the updated privacy policy. Where normal bone meets the necrotic segment a zone of increased radiographic density may be produced by new bone formation. Contrary to popular belief, rigid fixation delays rather than promotes fracture union. X-ray The fracture is clearly visible but the bone on either side of it may show either exuberant callus or atrophy. Nerve compression and entrapment. Nerve damage may result in motor and sensory loss. Accurately speaking, this is an early complication of bone injury, because ischaemia occurs during the first few hours following fracture or dislocation. 7. This is visible on X-ray and should fill the fracture by weeks 8-12 post-injury. Delayed union (fracture takes longer than normal to heal). There are, of course, also biological and patient-related reasons that may lead to non-union: (1) distraction and separation of the fragments, sometimes the result of interposition of soft tissues between the fragments (there is muscle or ligament covering the broken ends and preventing them from touching each other) (2) excessive movement at the fracture line (the two ends are still mobile ) . These orgs can survive in O 2 tension Toxins produced will destroy the cell wall and leads to tissue necrosis C/feature: within 24 hr. Principles of Fractures - . Visceral injury causing damage to structures such as the brain, lung or bladder. First rib or clavicle fracture (subclavian artery). Joint instability. feinstein october 2009. simple. Joint stiffness. Treatment -early diagnosis. Inflammation with swelling, lasting 2-3 weeks. Possible complications of open fractures. prevention. 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