Early complications of fracture

Fat Embolism
It is a life threatening complication of
fracture where fat globules occlude the
small blood vessels.
Embolism is the process of occlusion of
blood vessel by any material which is
brought to the site from elsewhere by
bloodstream.

Pathogenesis

Injury to large bones (e.g. femur) release fat

globule from bone marrow to blood stream.
Alternatively fat can also be released from the
adipose tissue.
The fat globules obstruct capillary vasculature of
the lungs.
Also, fat is converted to free fatty acid, which
induces toxic vasculitis followed by thrombosis
which obstruct the microvasculature.

Clinical features
COMMON
Patechial rash of anterior
neck, anterior axillary
fold or conjunctiva
CEREBRAL TYPE
Drowsiness
Restlessness
Disorientation
Coma

PULMONARY TYPE
Tachypnoea
Tachycardia
Respiratory failure

Diagnosis
Retinal artery emboli
Urine: fat globules
CXR: pulmonary
infiltration/
Snow storm
appearance

Management

Respitarory support
Heparinisation
i.v. low mol wt dextran
Corticosteroid
Dextrose and alcohol infusion to emulsify
fat.

Compartment syndrome
An increased pressure within enclosed
osteofascial space that reduces
capillary per-fusion below level
necessary for tissue viability; the
underlying mechanism is:
increased volume within space
decreased space for contents
combination of both

Etiology
Trauma with
bleeding/swelling
Bleeding disorders
Burns
Tight wraps
Traction
Surgical positioning
Pneumatic antishock
garment
Reprefusion swelling
Casting & Wraps

Pathophysiology:
Increased compartment pressure
leads to increased venous
pressure which decreases A-V
gradient resulting in muscle and
nerve ischemia.

Diagnosis
History
Clinical exam:the Ps
Laboratory tests
CPK
Urine myoglobin

Clinical features
The six Ps:
Pressure: palpation of compartment and its tension or firmness

Pain: Exaggerated with passive stretch of the involved

muscles in compartment
Earliest symptom but inconsistent
Paresthesia:Peripheral nerve tissue is more sensitive than
muscle to ischemia
Will progress to anesthesia if pressure not relieved
Paralysis: late finding
Pallor
Pulselessness

Treatment

Lower leg to level of the heart

Remove cast
Split all dressings down to skin
Fasciotomy if continued clinical findings
and/or elevated compartment pressure

Bone Infection- Osteomyelitis

Hematogenous
osteomyelitis
Infection (Staph
aureus) elsewhere in
body- introduced into
blood then bone

Etiology
Burns, CA tumor
necrosis, sinus, pressure
ulcer infection
Direct infection
open fracture,
penetrating wounds,
surgical contamination,
prostheses insertion

clinical features

fever
malaise
fatigue
irritablity
restriction of movement of limb
local edema,erythema and tenderness

Treatment
Sequestrectomy
Saucerisation
In saucerisation , the cavity is converted
into a saucer by removing its wall.This
allows free drainage of thr infected
material.
Curettage