Complications of Fracture – Compartment Syndrome

Compartment syndrome is a condition caused by increased pressure within a confined space, or compartment, in the body. It mostly is associated with fracture of tibia, forearm fractures, foot injuries and hand injuries.

Compartment syndrome results in ischaemia of the tissues. If untreated, it can result in necrosis  of the muscles and other tissues.

However, rapid diagnosis and treatment can lead to complete recovery.

How Does It Occur?

When fracture occurs, the force of injury also results in soft tissue injury. Bleeding from the bone or other tissues accumulate in muscle compartments which are limited by fasciae and muscular septae.  This causes elevation of the pressure in the compartment andcapillary blood flow is compromised. Read more

Complications of Fracture – Vascular Injury

Vascular injuries, especially arterial injuries may have disastrous consequences resulting in the loss of life and limb.
A vessel can get injured any where in its course but certain areas are more prone than others due to location of the vessel.
The axilla, medial and anterior upper arm, and antecubital fossa particularly are high-risk areas because of the superficial location arteries in these regions. In lower limb, the inguinal region, medial thigh, and popliteal fossa particularly are considered high-risk locations.

both in upper and lower limbs, there is one single vessel at the beginning of limb which divides into branches after it has traversed some distance. In upper limb this division is beyond elbow and in lower limb just below knee.

Thus before the furcation or division of the vessel, there is a single vessel supply and after furcation it becomes two in upper limb and three in lower limb. This is important because when injury is to a vessel above elbow or knee, it means loss of entire supply to the limb and thus risk of loss of limb. Read more

Complications of Fracture – Nerve Injury

Nerve injuries  and vessels injuries can occur with some fractures. Location of nerves and vessels in some areas make them vulnerable to injury. Most vulnerable areas are when nerve or vessel lies in close proximity to the bone in some fascial tunnel  rendering it not that mobile.

Both closed and open fractures can be associated with neurovascular injuries.  Nature of injury to these structures is more serious in case of open fractures. Generally speaking, nerve injuries are more common than vascular injuries.  Read more

Complications of Fracture – Infection

Infection can occur in the bone following a fracture by three means

• The fracture is open and wound gets infected by organism introduced from without.
• The fracture hematoma can get infected by organisms from bloodstream.
• Post surgical infection

Despite all the measures to control it, infection occurs in some open fractures and closed fractures. The incidence is higher in patients with extensive soft tissue injury.

First goal of the treatment is to prevent the infection. however, if an  infection develops it should be closed. If the infection is suoperficial and limited, local toileting and antibiotics help.

However in case the infection is quite deep, the measures should be taken accordingly. Drainage of pus, debridement of local necrotic tissues, irrigation of the wound are various local measures that can be used. Antibiotics are the drugs that kill the infective organisms but not all antibiotics have same spectrum of activity.

Therefore it is very important to know what organism has infected the wound. this can be done by taking discharge or pus from the wound and culture it to grow the inhabiting organisms. After they have been grown, organisms are tested against various antibiotics to know what inhibits the growth the greatest.

This test is called culture and sensitivity and helps to administrate appropriate drugs.

Superficial infections frequently respond to this treatment alone. If the infection appears to be deep, the wound should be opened to provide drainage and then splinted accordingly with plaster or external fixator.

If internal fixation is in place and the fixation device has not loosened, it should not be removed. Majority of internally fixed fracture  unite in spite of infection with antibiotic treatment and drainage. If fixation is loose, revising or removing the internal fixation and using external fixation to maintain stability and to allow dressing changes and wound care should be considered.

Other kind of infection that occur are late infection. This may cause loss of fixation and nonunion.

For late infections, when fixation has been lost and nonunion has developed an aggressive, the principle of treatment is that union of the fracture must be obtained even in the presence of infection.  Implant removal and  including removal of necrotic and infected diaphyseal bone should be done as these would contribute to the infection. The loss of bone resulted can be filled with graft.

The wound needs to be examined regularly to perform bone grafting at an appropriate time.

In spite of these measures a few patients go into chronic infection which is even more difficult to manage.

Complications of Fractures of Radius and Ulna – An Overview

The complications associated with these fractures can be due to injury per se, failure to get right treatment or complication of treatment as such. Many complications are general complications associated with any fracture and few are specific to these fractures.

Here is list of most common complications of these fractures.  We would be discussing important ones in detail in upcoming articles.

• Infection
• Nerve Injury
• Vascular Injury
• Compartment Syndrome
• Posttraumatic Radioulnar Synostosis
• Refracture
• Muscle and Tendon Entrapment and Adherence
• Malunion
• Nonunion
• Soft Tissue Contracture
• Subluxation/dislocation of the distal radioulnar joint in Galeazzi fracture
• Radial head instability in Monteggia fracture dislocation

List of Complications Of A Fracture

Complications of a fracture can be due to injury per se, problems of healing or as an unwanted effect of treatment. Sometimes complications of the fracture injury become much more important than fracture itself because of life threatening or limb threatening nature.

Most of the complications though are of not this nature. A physician must take into account the potential complications and patient should be monitored regularly since the time of arrival for early signs pointing to fracture.

The complications can be listed as local or pertaining to the injured region and systemic or involving other systems of body.

They can also be divided into early and late. Early complications are those which occur at time of injury or within a short period after injury due to factors related to injury.

Late complications are those which occur after a substantial time has passed and are as a result of defective healing process or because of the treatment itself. Read more

Operative Treatment of Monteggia Fracture Dislocation

Adult Monteggia fractures rarely yield to closed reduction. Most of the time operative treatment is needed. The goal is to fix ulna in anatomical position and reduce radial head. Ulna is usually fixed by a 3.5-mm limited-contact dynamic compression plate .

Monteggia fractures should be operated as soon as feasible. patient is placed in supine or lateral position depending upon surgeon’s convenience.

After stabilization of the ulna, the elbow is passively ranged to assess the stability of the radial head. An image intensifier can help assess radial head stability. After the surgery wound is closed in layers without closure of fascia.

If there is a radial or posterior interosseous nerve palsy that has occurred with injury, the course of action depends on reduction of radial head. if the reduction of radial head occurs easily, exploration of the radial or posterior interosseous is not indicated. Read more

An Overview of Spinal Injuries

Over the years, outcome of injuries to the spine have changed. This has been achieved by better understanding of the factors that produce injury and improved care. But still it is a major challenge to cure associated neurological deficit. The science is working on it and hopeful to find a method but as of now we do not have a way to treat neurological loss in pure sense.

Most common injuries in a trauma victim are head injuries and skeletal injuries. Injury to the spinal column is relatively less common and has a prevalence of 6%. it could be at a single level or may involve multiple non contiguous vertebrae. Roughly 20% of spine injury patients have involvement of multiple levels. Read more

Monteggia Fracture Dislocation – Biomechanics of Injury and Principles of Treatment

Monteggia fracture dislocation is an indirect injury. That means forces causing the fracture are tranmistted rather than direct.
Here is what is thought about forces of these fractures.

Type I injuries occur because of forced pronation of the forearm. this results in fracture of ulna and anterior dislocation of the forearm.

Type II lesions is posterior angulated fracture of the ulna, and a posterior dislocation of the radial head. Type II lesion is thought to be a variation of an elbow dislocation in which the ulnar shaft fails before the medial ligament of the elbow ruptures. Read more

Monteggia Fracture Classification

Classification of Monteggia fractures were given by Bado. Initially Bado described four types of this lesion.

Type I

Fracture of the ulnar diaphysis at any level with anterior angulation at the fracture site and an associated anterior dislocation of the radial head.

Read more

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