8. Get powerful tools for managing your contents. Union by primary bone healing is slow, but provided stability is maintained throughout, it does eventually occur. Certain body sites are more common for nonunion because of poor blood supply including the fifth metatarsal, tibia, hamate and scaphoid bones. COMPLICATION OF FRACTURE General Local Early Late. Fracture complications include: Acute. 7- Thrombo-embolism. There is no advantage to puncturing the blisters (it may even lead to increased local infection) and surgical incisions through blisters, whilst generally safe, should be undertaken only when limb swelling has decreased, Plaster and pressure sores Plaster sores occur where skin presses directly onto bone. Presentation Transcript. Inside each layer of fascia is a confined space, called a compartment, that includes the muscle tissue, nerves, bones and blood vessels. The median nerve is most at risk with . * 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. -fluid replacement -intravenous antibiotics -Hyperbaric oxygen has been used for limiting the spread of gangrene. Late complications of fractures - Outlines. Complications of Diabetes, Diabetes Complications, Long-term complications of diabetes, major complications of - Do, Principles of fractures - . Source : bone marrow more common in patients with multiple fractures. B-Over-rigid fixation. Possible complications of open fractures. 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. Late complications of fractures - . (c) gradual collapse of comminuted bone . The SlideShare family just got bigger. Fractures are common: most people will experience at least one during a lifetime. Elbow dislocation (Brachial artery). until the total vascularity of the muscles and nerves is jeopardized. (( open wound then this should be managed)) . Many fac-tors influence the speed with which fractures heal (Chart 69-3). Complications Current trends Conclusion . An arterial injury may result from laceration, thrombus, embolus, intimal tear, or pseudoaneurysm . Methods: A total of 402 patients with high-energy tibial fractures treated using preoperative external traction fixation at a Level 1 trauma center from 2014 to 2018 were enrolled in this retrospective study. Introduction. with the end of the lecture. Pulmonary embolism. Tendon lesions. The compromised limb is pulseless,red, swollen,blistered; sensation and muscle power may be lost. Gas gangrene. 1) rib fractures : pneumothorax - penetration of the lung Spleen trauma Liver injury 2) pelvic fractures - rupture of the bladder or urethra. Septic shock. 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. Crush syndrome. 6- Multiple organs failure syndrome (MOFS). 3. Fasciotomy (surgical decompression of the fascia) Wound left open 3-5 days . Enjoy access to millions of ebooks, audiobooks, magazines, and more from Scribd. of ulna and radius. 5. spring 2012. risk factors. -mainstay of treatment is prompt decompression of the wound and removal of all dead tissue. B-Severe soft tissue damage Severe damage to the soft tissues affects fracture healing by: (1) reducing the effectiveness of muscle splintage ; (2) damaging the local blood supply and (3) diminishing or eliminating the osteogenic input from mesenchymal stem cells within muscle. Complications are a reality of fracture repair. -spontaneous recovery awaited occurs in 90% within 4 months. 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 . General complications Shock Hypovolemic or hemorrhagic shock. Complications of fractures Types Early - General - Local Late - General - Local Early general Revascularization 3.Excision of the avascular segment 4.Total joint replacement. X-ray The fracture is clearly visible but the bone on either side of it may show either exuberant callus or atrophy. Enjoy access to millions of ebooks . Early: 1. General . Complications usually happen more in open than in closed . principles of fractures definition. We've encountered a problem, please try again. vascular injury forearm compartment syndrome resulting in volkmanns, LATE COMPLICATIONS OF FRACTURES - . Knee dislocation (Popliteal artery). General . Haemoarthrosis. 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. bld flow coz Ischemia leads to tissue death & peripheral gangrene. Aim: To analyze the early complications associated with preoperative external traction fixation in the staged treatment of tibial fractures. (5) infection (particularly osteomyelitis ) . Others are unavoidable but their resolution may be aided by early diagnosis and appropriate treatment. A few guidelines are offered:- 1. C- Periosteal stripping over-enthusiastic stripping of periosteum during internal fixation is an avoidable cause of delayed union . 6. Both occur during limb swelling and are due to elevation of the epidermal layer of skin from the dermis . -paralysis -pain If a vascular injury is suspected an angiogram should be performed immediately; if it is positive, emergency treatment must be started without further delay Treatment All bandages/splints removed The fracture re X-Rayed Circulation reassessed for next half hour If no improvement, do vessels exploration Suture torn vessels, vein grafting, if thrombosed do endarterectomy Aim: to restore blood flow, Nerve Injury * Nerve injury is particularly common with fractures of the humerus or injuries around the elbow or the knee. Plaster and pressure sores. Complications of Fractures: 1-General complications: shock..etc 2-Local complications: Early Late. *The effects vary -transient diminution of blood flow -profound ischaemia -tissue death -peripheral gangrene. This article highlights 2 important complications of fracture: acute compartment syndrome and fat embolism syndrome (FES). Osteoarthritis. 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. A bone fracture can be the result due to high force impact or stress, or trivial injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, bone cancer, or osteogenesis . medical ppt. COMPLICATIONS OF FRACTURES. *These injuries require emergency treatment. 45. As a general rule , union is deemed to be delayed if the fracture is still freely mobile after 3 or 4 months . Associated systemic illness . INFECTION Causes: Open fracture (common) Use of operative method in the Tx of # Wound becomes inflamed and starts draining seropurulent fluid. C/Feature : The joint is swollen and tense and patient will resists any movement. Medications may impair healing of fractures. Fasciotomy is performed. 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. Many can be avoided or minimized by being aware of their pathophysiology and predisposing factors. This is visible on X-ray and should fill the fracture by weeks 8-12 post-injury. 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. 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. orbital (60-75%) intracranial (15-20%) bony (5-10% ) radiography. a vicious circle that ends after 12 hours or less, in necrosis of nerve and muscle within the compartment. 2. Fibrous tissue in the fracture gap, as well as the hard, sclerotic bone ends is excised and bone grafts are packed around the fracture. 13. Local . This can take several years, depending on the site. If there is muscle necrosis debridement If muscle is healthy suture (w/o tension)/ skin grafted / simply heal by 2 intention. Joint stiffness. bone breaks cleanly but does not penetrate the skin. The most difficult recovery happens in this type of fracture. 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 . fractures of alveolar, Complications of Sinusitis - . Examples include the ankle, wrist, elbow and foot. clinically: - should be tested by stretching the muscles when the toes or fingers are passively hyperextended there is pain in the calf or forearm. professor consultant orthopedic and, FRACTURES - . of blood within the joints. 3. a disruption or break in the continuity of the structure of bone traumatic injuries account, FRACTURES - . with the end of the lecture. x-rays of fractures for salter harris, Fractures - . closed. Nerve injury. 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 . 2 Categories of Fracture Complications. Complications of Fractures:. A complication of shoulder fracture or . By accepting, you agree to the updated privacy policy. The reduction of fracture fragments must be accurate and main-tained to ensure healing. Late. Nerve damage may result in motor and sensory loss. 5- Crush syndrome. FRACTURES
AnandkumarBalakrishna
Wong Poh Sean
MohdHanafiRamlee
. Major complications of fracture repair include ost 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. 4- Severe cases: respiratory distress and coma, due to brain emboli and hypoxia from involvement of the lungs. C-Infection. The wounds should be left open and inspected 2 days later: if there is muscle necrosis, debridement can be carried out; if the tissues are healthy, the wounds can be sutured (without tension) or skin-grafted. Principles of Fractures - . Instant access to millions of ebooks, audiobooks, magazines, podcasts and more. 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. There is no effective antitoxin against C. welchii. HAEMARTHROSIS Fractures involve joints, leads to acc. Excision of dead muscle must be radical to avoid sepsis. Accurately speaking, this is an early complication of bone injury, because ischaemia occurs during the first few hours following fracture or dislocation. professor consultant orthopedic and, FRACTURES - . Have u ever tried external professional writing services like www.HelpWriting.net ? Get powerful tools for managing your contents. Inflammation with swelling, lasting 2-3 weeks. Visceral injury causing damage to structures such as the brain, lung or bladder. In closed injuries nerve is seldom severed and spontaneous recovery should be awaited. General complications Shock Hypovolemic or hemorrhagic shock. Wound becomes inflamed and starts draining seropurulent fluid. Life-threatening complications. general, Late complications of fractures - . 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 . However , the clinical and radiological effects are not seen until weeks or even months later, the avascular bone gradually loses its rigid trabecular structure , in this state the bone crumbles easily and under stress imposed by the muscular tone or body weight it will eventually collapse which may be sometimes very slow. A recent motor vehicle accident (one month or less prior to fracture). . description. fractures of alveolar, The earliest of the classic features are pain (. Post-traumatic wound infection is now the most common cause of chronic osteitis. Slides: 23. 1- Blood loss 2- Shock *Hypovolemic or hemorrhagic shock. *The patients expectations (often prompted by cosmesis) may be quite different from the surgeons; they are not to be ignored. Multiple organs failure syndrome (MOFS). Fat embolism. Nerve damage may result in motor and sensory loss. Period of active resuscitation. General complications. fractures of teeth. x-rays of fractures for salter harris, Fractures - . Complications of Fractures. 3. -The injured limb is cold, pale, or slightly cyanosed. Create stunning presentation online in just 3 steps. Fracture is a medical condition which leads to break in the continuity of the bone. In extreme case gangrene Treatment -Decompression of the compartment. The blood should be aspirated before dealing with the fracture. 2- Biomechanical cause :- A-Imperfect splintage. 3. frango, 3. fregi, fractum to break, Complications of Pregnancy - . http://hastaneciyiz.blogspot.com. 1- Blood loss 2- Shock *Hypovolemic or hemorrhagic shock. a bone fracture (sometimes abbreviated, Types of Fractures - . Tx : the blood should be aspirated before dealing with the fracture. (features) The joint is swollen and tense and the patient resists any attempt at moving it. 2. Pt complains: - intense pain - swelling around the wound - brownish discharge - gas formation - pyrexia - characteristic smelling - PR - toxaemic coma death Inability to recognize may lead to unnecessary amputation for the non-lethal cellulitis. 4. (( 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. 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. 12. 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. Looks like youve clipped this slide to already. (3) poor soft tissues (from either the injury or surgery) . Venous thrombosis 7. 5. Rotational deformity of the femur, tibia, humerusor forearm may be missed unless the limb is compared with its opposite fellow. *Clinical features Early warning signs of fat embolism (usually within 72 hours of injury) are 1- slight rise of temperature and pulse rate. 2022 SlideServe | Powered By DigitalOfficePro, - - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -. Fascia separate groups of muscles in the arms and legs from each other. Clinical features :- The deformity is usually obvious, but sometimes the true extent of malunion is apparent only on x-ray . Activate your 30 day free trialto unlock unlimited reading. Thrombo-embolism. Bed sore. Skin necrosis 2. Infection. by encouraging weightbearing). Smoking . 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. delayed union and nonunion avascular necrosis of bone reaction . 14. 3,4 All nerves crossing the elbow may be injured, with the commonest being the median and its anterior interosseous branch. Compartment syndrome 6. - 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 . 10. feinstein october 2009. simple. Late 1. -by agent causing fracture Acute nerve compression -Distinct from a direct injury, with fractures or dislocations around the wrist. This takes until week 4-8 post-injury and is not visible on X-ray. Fractures are associated with a range of potential complications. 4. Joint instability. Humeral supracondylar fracture (brachial artery). a bone fracture (sometimes abbreviated, Types of Fractures - . OPEN FRACTURES COMPLICATIONS: OSTEOMYELITIS, RAD 422 Fractures Types, Complications, and management - . General complications. Common vascular injuries may associate with the following fractures. 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. Contact Was there sufficient contact between the fragments? NONUNION OF FRACTURES - Introduction:. a- immediate or operative complications. dr. abdulrahman algarni , md, ssc (ortho), abos assist. Soft callus formation a decrease in swelling as new bone formation begins, fracture site stiffens. Management involves delay in surgical intervention and casting. closed. . Shortening It is a common complications of fractures and results from:1. Malunion (fracture does not heal in normal alignment). In the forearm and leg a single-bone fracture may be held apart by an intact fellow bone. Free access to premium services like Tuneln, Mubi and more. 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. Complications of fractures. In children, angular deformities near the bone ends (and especially if the deformity is in the same plane as that of movement of the nearby joint) will usually remodel with time; rotationaldeformities will not. Antibiotics are needed, while the wound has to be tendered by a surgeon. Done by: S elena abboud Rand A lshayeb Rahaf H asanain. If there is significant die-back, this will require more extensive excision and the gap is then dealt with by bone advancement using the Ilizarov technique. RAD 422 Fractures Types, Complications, and management - Rad 422 fractures types, complications, and management. of ulna and radius. *Neurogenic shock. spiral fracture. vascular injury forearm compartment syndrome resulting in volkmanns, LATE COMPLICATIONS OF FRACTURES - . 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.. "/> Fasciotomy Compartment pressure, A vicious cycle cont. Hip fractures, particularly in elderly patients, lead to loss of mobility which may result in pneumonia, thromboembolic disease or rhabdomyolysis. age under 17 over 35 gravida and parity socioeconomic status, Complications of Exodontia - . MALUNION When the fragments join in an unsatisfactory position (unacceptable angulation, rotation or shortening) the fracture is said to be malunited. 1. frango, 3. fregi, fractum to break, Complications of Pregnancy - . *Septic shock. COMPLICATIONS OF FRACTURES. Complications of fractures Done by: Selena abboud Rand Alshayeb RahafHasanain, COMPLICATIONS OF FRACTURES General Local Early Late. Fracture blisters. (d) osteoporotic bone . Injuries to adjacent structures. 3. Excessive traction (creating a fracture gap) or excessive movement at the fracture site will delay ossification in the callus. While age-adjusted incidence is decreasing, the overall prevalence of hip fractures has increased globally with the aging population [1, 2].The number of hip fractures is projected to more than triple between 1990 and 2050, with an estimated 4.5 million cases expected per year globally []. 3- Pathognomonic signs are petechiae on the trunk, neck, axillae and conjunctiva. 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]. bone breaks cleanly but does not penetrate the skin. shock follows a mismatch of metabolic demand to oxygen delivery at tissue level, leading to cellular hypoxia and (if uncorrected) to tissue and organ failure. 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. In open fractures complete lesion(neurotmesis) : the nerve is explored during wound debridement and repaired. Acute complications occur as a direct result of the trauma sustained and can include damage to vascular structures, nerves, or soft tissue. First rib or clavicle fracture (subclavian artery). Shock fat embolism compartment syndrome deep vein thrombosis thromboembolism (pulmonary embolism) disseminated intravascular coagulopathy, and infection. [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]. 8. This is a tabulated compilation for complications of fractures in general which can be immediate, early or delayed and local or generalized/systemic. feinstein october 2009. simple. 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. Causes are (a) failure to reduce a fracture adequately . Fracture Healing and Complications (Early and Delayed) Weeks to months are required for most fractures to heal. 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. 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. (c) Pulsed electromagnetic fields and low-frequency, pulsed ultrasoundcan also be used to stimulate union . - 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. Cardio Training for Judo: Fitter, Faster, Stronger and more Agile fast! hemothorax occur from displaced clavicular fracture. Stability Was the fracture held with sufficient stability? 2- breathlessness ,mental confusion ,restlessness. (7) non-compliance on the part of the patient . The operation should be planned in such a way as to cause the least possible damage to the soft tissues. Acute complications are generally those occurring as a result of the initial trauma and include neurovascular and soft tissue damage, blood loss and localised contamination and infection. type causes investigation symptoms, Fractures - . It appears that you have an ad-blocker running. 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. Infection may be superficial, moderate (osteomyelitis), severe (gas gangrene). Visceral injury (the lung, the bladder, the urethra, and the rectum). Local . COMPLICATION OF FRACTURE General Local Early Late. (e.g. Confirmation of the diagnosis is by measuring the intra compartmental pressures. 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 . Artery may be cut, torn, compressed or contused. Malunion. Treatment -early diagnosis. Oestrogen-containing hormone therapy (although this may be a proxy for osteoporosis). Haemarthrosis Fractures involving a joint, leads to accumulation of blood. three main categories. types of fractures:. Therefore, reevaluation at regular intervals during . Late. The wound should be left open and inspected 2 days later. ? Hard callus formation as new bone bridges the fracture site. Skin loss is present and extensive, muscles are severely damaged, tendons and other tissues are also affected. Type I open fracture can be managed with non-operative approach and closed reduction. The SlideShare family just got bigger. -The P monitored; if it falls below 30 mmHg, immediate open fasciotomy is performed. Early complications include shock, fat embolism, compartment syndrome, deep vein thrombosis, thromboembolism ( pulmonary embolism ), disseminated intravascular coagulopathy, and infection. Fat embolism. (4) poor local blood supply ( avascular necrosis ) . Principles of Fractures - . Causes:- When dealing with the problem of non-union, four questions must be addressed. *Septic shock. Early preventing : limb elevation Dx : confirmed by direct intracompartmental pressure measuring > 40 mm. They have given rise to the acronym CASS: 1. Create stunning presentation online in just 3 steps. 15-3 ). Pulmonary embolism. Enter your email address to subscribe to this blog and receive notifications of new posts by email. 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. spring 2012. risk factors. Early. high urine flow is encouraged with alkalization of the urine with sodium bicarbonate, prevents myoglobin precipitating in the renal tubules. what's fracture of ulna and radius? objectives. Growth defects: growth plate or epiphyseal injuries. Infection Open fractures may become infected; closed fractures hardly ever do unless they are opened by operation. Infection may be superficial, moderate (osteomyelitis), severe (gas gangrene). 6. They should be prevented by padding the bony points and by moulding the wet plaster so that pressure is distributed to the soft tissues around the bony points. 4- Pulmonary embolism. Hip fractures, particularly in elderly patients . Complex regional pain syndrome. Alignment Was the fracture adequately aligned , to reduce shear? Weve updated our privacy policy so that we are compliant with changing global privacy regulations and to provide you with insight into the limited ways in which we use your data. I did and I am more than satisfied. 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 . This is particularly important during the first 3 weeks, when the situation may change without warning. Growth disturbance. Stimulation Was the fracture sufficiently stimulated? 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. Intima may be detached, thrombus block, artery spasm Effect ? Fracture : Diagnosis, Complications and Prevention. the classical form of MODS appears to progress through four clinical phases: 1. The bone ends are rounded with no suggestion of new bone formation. With modern medical and surgical care most heal without problems or significant loss of function. Silver sulfadiazine seemed in one review to promote re-epithelialisation. Acute long bone fractures primarily result from significant trauma. GAS GANGRENE Produced by anaerobic orgs : Clostridium sp infections. 4. 4. type causes investigation symptoms, Fractures - . The affected bone must have an adequate blood supply. Patients who are treated surgically, but fail acutely face a more complex operat With atrophic non-union, fixation alone is not enough. Muscle will be dead after 46 hours of total ischaemia. If they are displaced, surgery is often needed to set them properly. General complications 1- Blood loss 2- Shock *Hypovolemic or hemorrhagic shock. Nerve damage may result in motor and sensory loss. Patients with multiple rib fractures may develop pneumothorax, flail chest and respiratory compromise. 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. Avascular necrosis. Shoulder dislocation (Axillary artery). principles of fractures definition. Gas gangrene 4. -The nerve should be explored at the time of debridement and repaired at the time or at wound closure. 1. You can read the details below. - PowerPoint PPT presentation. It is only because the fixation device holds the fragments so securely that the fracture seems to be uniting. While a plaster sore is developing the patient feels localized burning pain. Gas gangrene. Outcome of surgically treated acetabular fractures: risk factors for postoperative complications and for early conversion to total hip arthroplasty On x-ray, the fracture line remains visible and there is very little or incomplete callus formation or periosteal reaction. X-rays are essential to check the position of the fracture while it is uniting. Early complications. 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. OPEN FRACTURES COMPLICATIONS: OSTEOMYELITIS, RAD 422 Fractures Types, Complications, and management - . *Management -ABC -Oxygen -fluids -Inotropes/vasopressors: if the patient remains hypotensive despite adequate fluid resuscitation -systemic support for other organs. EARLY COMPLICATIONS Early complications may present as 1- part of the primary injury or 2- may appear only after a few days or weeks. 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. Contrary to popular belief, rigid fixation delays rather than promotes fracture union. Tap here to review the details. 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. delayed union non-union malunion joint stiffness myoisitis ossificans avascular. - Casts, bandages and dressings must be completely removed. Fracture complications are often variably defined, and there is a lack of consensus in their assessment, which makes their incidence difficult to estimate. 2. classification of fractures. At this stage it is sometimes difficult to decide what constitutes malunion ; acceptable norms differ from one site to another . View 2.Complications of Fractures.pdf from SDGSG 6474 at Jordan University of Science & Tech. Age . In adults, fractures should be reduced as near to the anatomical position as possible. Early. 9. By whitelisting SlideShare on your ad-blocker, you are supporting our community of content creators. The pressure within the affected compartment increases, resulting in muscular fibrosis and neurological damage. CLINICAL FEATURES Pt with ischemia may have 5 Ps: - paraesthesia/numbness - pain - pallor - pulselessness - paralysis Investigate if suspect vascular injury : Angiogram, TREATMENT Emergency treatment All bandages/splints removed The fracture X-Ray again Circulation reassessed for next half hour If no improvement, do vessels exploration Suture torn vessels, vein grafting, if thrombosed do endarterectomy Aim: to restore bld flow. -pulse is weak or absent. Learn faster and smarter from top experts, Download to take your learnings offline and on the go. 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. Fracture blisters 3. Delayed union. 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. 1-general complications: shock..etc 2-local complications: early late. The fracture edges will become necrotic and dependent on the formation of an ensheathingcallus mass to bridge the break. introduction. 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 . Click here to review the details. Crushing: Actual bone loss 3. Gas gangrene. . 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. Multiple organs failure syndrome (MOFS). mohammad ararawi. Damage to surrounding tissue, nerves or skin. 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. Treatment include conservative treatment ,drainage of the hemothorax and operative fixation Neurogenic shock. If compartment syndrome develops, and is confirmed by pressure measurements, then a fasciotomy is indicated. Crush syndrome. (within 12 hours) The necrotic muscle undergo healing with fibrosis, leading to Volkmanns contracture. Thrombo-embolism. Clinical features :- Avascular necrosis causes : intractable non union , disabling osteoarthritis or total disorganization of a joint . lecture .4. l earning objectives. Even if symptoms are present, operation is not the only answer; with hypertrophic non-union, (b) functional bracing may be sufficient to induce union, but splintageoften needs to be prolonged. Muscle contracture. Number of Views: 3789. Delayed complications may occur after initial treatment or in response to treatment. . 1-General complications: shock..etc 2-Local complications: Early Late. 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. 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. (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 /> . If the zone of necrosis is extensive, as might occur in highly comminuted fractures, union may be interrupted . 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. Closed nerve injuries -The nerve is seldom severed. Typically, after a broken bone, imaging is ordered to see if the broken limbs are displaced. fall 2011. risk factors. Pages 5. swelling around the wound, brownish discharge gas formation, Prevention: deep penetrating wound in muscular tissue are dangerous; should be explored, all dead tissue should be completely excised, and if there doubt about the tissue viability should left open the wound Treatment: Early Dx is life saving General measures: Fluid replacement & IV Antibiotic (immediate) Hyperbaric O 2 (limiting the spread of gangrene) Mainstay : prompt decompression & remove dead tissue, A think local act local multicountry type of strategy, A "think local, act local" multidomestic type of strategy, Why does liver disease cause splenomegaly, DIABETIC COMPLICATIONS COMPLICATIONS COMPLICATIONS COMPLICATIONS COMPLICATIONS CVD Risk, Greenstick fracture Transverse fracture Fracture Epiphyseal Fracture Torus, Bone Fractures Bone Fractures Fracture broken bone General, COMPLICATIONS OF FRACTURES Local complications can be divided, COMPLICATIONS OF FRACTURES By Dr Jasim Hasan COMPLICATION, Complications of Fractures 1 General complications shock etc, Complications of fractures 1 The general complications of, FRACTURE q Brittle Fracture criteria for fracture q, Fracture Mechanics Brittle fracture Fracture mechanics is used, Fracture numrique fracture sociale fracture de paradigme Daniel, Eponymous Fractures Boxers Fracture fracture of metacarpal bones, Bone Fractures Complete Fracture Radius Compound Fracture Complete, Fracture Repair Anatomy Physiology Fracture Repair Fractures are, Fractures Fundamentals Unit 12 Fractures l Fracture a, Fractures du rachis Fractures du rachis cervical Fracture, Radiographic Pathology Fractures and Related Injuries Fractures Fractures, Panfacial Fractures Panfacial Fractures Panfacial fractures can be, Complications of Fractures 1Nonunion Nonunion consider if fracture, Complications in Fracture Healing 1 Delayed union Fractures, Pelvic Fracture Complications Early complications Associated conditions Delayed, LATE COMPLICATIONS OF FRACTURES LATE COMPLICATIONS Delayed union, Contraindications and Complications of Local Anesthesia Local Complications, Local Complications in Anesthesia Administration Local Complications Needle, LES COMPLICATIONS Complications aigues Complications chroniques I LES. A rise in pressure within these compartments may jeopardize the blood supply to the muscles & nerves within the compartment. what's fracture of ulna and radius? 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. Bone remodelling the bone remodels to correct deformities in the shape and loading strength. 4. Delayed complications may occur after initial treatment or in response to treatment. Nerve is capable of regeneration but muscle, once infarcted, can never recover and is replaced by inelastic fibrous tissue (Volkmanns ischaemic contracture). Now customize the name of a clipboard to store your clips. -Skin sensation repeatedly checked- Ischaemic muscle is highly sensitive to stretch. Delayed complications include delayed union and nonunion, avascular necrosis of bone . delayed union non-union malunion joint stiffness myoisitis ossificans avascular. outlines. Certain regions are known for their propensity to develop ischaemia and bone necrosis after injury . Pelvic fracture (presacral and internal iliac). The onset of both of these complications may be difficult to assess . 2. Organ failure Management: Prevention, remove risk factors, oxygen,treat underlying cause, Local complications - Early Visceral injury Vascular injury. 2. Delayed complications. The features at this stage are essentially those of ARDS. Nerve compression and entrapment. a- immediate or operative complications. 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. a disruption or break in the continuity of the structure of bone traumatic injuries account, FRACTURES - . Nerve injury. Acute complications occur as a direct result of the trauma sustained and can include damage to vascular structures, nerves, or soft tissue. In hypertrophic non-union the bone ends are enlarged, suggesting that osteogenesis is still active but not quite capable of bridging the gap. Complications of Diabetes, Diabetes Complications, Long-term complications of diabetes, major complications of - Do, Principles of fractures - . Haemoarthrosis. A window must immediately be cut in the plaster, or warning pain quickly abates and skin necrosis proceeds unnoticed. In the case of the leg, fasciotomy means opening all four compartments through medial and lateral incisions. However, fractures are associated with a range of complications. Septic shock. Use of non-steroidal anti-inflammatory drugs (NSAIDs) within 12 months. Tetanus. maja roman vanja niki mentor: a. mega horvat. 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. One of the most serious and most common complications of a bone fracture is called malunion. fall 2011. risk factors. (b) failure to hold reduction while healing proceeds . Gangrene of limb 5. Exacerbation of underlying diseases such as diabetes or coronary artery disease (CAD). 6. fractures of teeth. http://hastaneciyiz.blogspot.com. Done by: S elena abboud Rand A lshayeb Rahaf H asanain. Complications of fractures. delayed unioun non, Complications of Supracondylar Fractures - . Stable hypermetabolism (systemic inflammatory response). mohammad ararawi. Loss of initial reduction or fixation Shock (hypoperfusion). 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 ) . (6) associated drug abuse, anti-inflammatory or cytotoxic immunosuppressant medication . objectives. age under 17 over 35 gravida and parity socioeconomic, Complications of Pregnancy - . They are believed to result from large strains applied to the skin during the initial fracture deformation, and they resemble second-degree burns rather than friction blisters. medical ppt. 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. -The limb should be nursed flat (elevating the limb causes a further decrease in end capillary pressure and aggravates the muscle ischaemia). 7. Complication of fracture 1. . Gas gangrene---characterized by myonecrosis, There are, of course, also biological and patient-related, 3. *Septic shock. They are: (1) the head of the femur (after fracture of the femoral neck or dislocation of the hip) (2) the proximal part of the scaphoid (after fracture through its waist); (3) the lunate (following dislocation) (4) the body of the talus (after fracture of its neck). 8. Compartment syndrome. spiral fracture. 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. General complications. Fracture blisters. delayed uniounnon unionmalunion avascular necrosisosteoarthiritisshortening. In atrophic non-union, osteogenesis seems to have ceased. 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) Therefore, reevaluation at regular intervals during . Faculty of Medicine, University of Malaya, Malaysia. Causes: -any injury/infection leading to edema of muscle -fracture haematoma within the compartment -ischemia to the compartment leading to muscle oedema -Due to tight bandages or casts Hallmark Symptoms: - severe pain that does not respond to elevation or pain medication. Avg rating:2.0/5.0. Compartment syndrome. delayed unioun non, Complications of Supracondylar Fractures - . 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. Arterial. This contrasting appearance has led to non-union being divided into hypertrophic and atrophic types. 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. outlines. 5. The appearances suggest that , although the fracture has not united, it eventually will. Clinical features :- Fracture tenderness persists and, if the bone is subjected to stress, pain may be acute . Compartment syndrome (or Volkmanns ischaemia). Mal union of the long bones 2. Delayed union (fracture takes longer than normal to heal). These complications have been observed in Very few patient of clavicle fractures, and the coexistence of scapular or upper ribs fractures should increase the risk of Pneumothorax- hemothorax. Fractures are associated with a range of potential complications. 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. 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. 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