Complications ofFractures
Dr. Wahby GhalibCABMS, FJMC, MRCS
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4Visceral injury
Rib # pneumothorax
Pelvic # bladder or urethral injury
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Vascular injury
Sites : knee elbow femur humerus
Types : compression
tear
intimal flap thrombosis
spasm
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7Dx : angiography
Tx : reductionrepair ± vein graft
endartectomyWahby Ghalib
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Nerve injury
Sites : humerus elbow knee
Closed # : 90% recovery in 4 mo
Exploration :no recovery (clinical & EMG)
open #
after manipulationWahby Ghalib
9Compartment syndrome
D : ↑ pressure in an osseofascial
compartment capillary occlusion
Nr. : 0-12 mmHg
Compartment :
>30or difference from DBP<30
Follows : # surgery plaster
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10After 12 hr muscle & nerve
necrosis Volkmann`s contracture
CF : pallor pain paraesthesia
paralysis pulselessnesspainful passive stretching
Dx : pressure measurementTx : fasciotomy
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11Haemarthrosis
Blood accumulates inside the joint
Aspirate
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Infection
Open # or IF
Complications :
delayed unionnonunion
chronic OM
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Problems of union
Delayed union: no clinical & radiological evidence of union by the assumed time.Usually by 3-4 m.
Nonunion : …..by double the union time.Usually by 6
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Causes
Biological : severe s.t. damage
inadequate bld supply
s.t. interposition
Biomechanical : imperfect or rigid
fixationInfection
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Tx
IF + bone graft
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17Malunion
Healing in an unacceptable position
Angulation > 10-15°
Shortening in L.L. > 2 cmWahby Ghalib
18AVN
Common #s : FN scaphoid talus
XR : > 8w
↑ densitycollapse
OA
Tx : arthroplasty
arthrodesis
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21Growth disturbance
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22Myositis ossificans
= heterotopic ossification
Common sites : elbow & hip
CF : pain & LOMRx : avoid vigorous exercise
excision after several monthsindomethacin & radiation ( prevention)
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24Tendon lesions
TP tendinitis in MM #
EPL tendon rupture in DR #
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25Nerve compression
Ulnar N. in cubitus valgus
Median nerve in DR #Wahby Ghalib
26Muscle contracture
DDx : claw-hand deformity
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Joint complications
Instability
Stiffness : ( fracture disease)
OA : damage to articular cartilage
malunited intra-articular #Wahby Ghalib
28Reflex sympathetic dystrophy
= complex regional pain s.
= algodystrophy= Sudeck atrophy
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Reflex sympathetic dystrophy
May be : ↑ sympathetic activity
Common sites : hand & foot
May follow trivial trauma
CF : pain swelling redness stiffness
XR : patchy osteopeniaWahby Ghalib
30Tx
PT
Antiinflammatory drugs
Sympatholytic (guanithidine)Sympathectomy
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32Shock
Hypovolaemic shock :
FS # 1-2 L
pelvic # 1-3L
Spinal shock : due to spinal cord inj.
flaccid paralysis &
peripheral vasodilatation
Neurogenic shock : spinal cord inj.
proximal to T6Wahby Ghalib
33Crush syndrome
Crushed limb deprived of blood tissue death accum. of toxic metabolites
Re-perfusion local swelling
dissemination of free
radicals & myoglobin
Hyperkalaemia hypocalcaemia acidosis
Cardiac arrestRenal failure
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Fat embolism
Seen 1-3d after trauma
CF : cerebral pulmonary cutaneous
Mortality : 15%Prevention : early # stabilization
Rx : mechanical ventilationWahby Ghalib
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36ARDS
Pulmonary oedema of non-cardiac
cause
Mortality rate 50%
Prevention : early # stabilization
Rx : mechanical ventilationObjectives :
Understanding the systemic approach to the complications of fractures.Building up of a rational way to deal with complications based on clinical priorities.
Understanding the special characters of each fracture and the possible respective complications.Wahby Ghalib
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Objectives :
Training the students about the prevention and the early detection of complications.Training the students on how to deal with complications the clarification of the various medical and the surgical options and stressing the importance of collaboration with the physeotherapist.
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