Complications of fractures

Complications of fractures

• Prevent complications of immobility
  • Constipation
  • Renal calculi
  • Cardiopulmonary deconditioning
  • DVT/pulmonary emboli
• Infection
  • High incidence in open fractures and soft tissue injuries
  • Devitalized and contaminated tissue  an ideal medium for pathogens
  • Prevention is key
  • Can lead to chronic osteomyelitis
  • Antibiotics for treatment
• Compartment Syndrome
  • Swelling and increased pressure within a confined space
  • Compromises neurovascular function of tissues within that space
  • Usually involves the leg but can occur in any muscle group
  • Two basic types of compartment syndrome
  • Decrease compartment size
  • Increase compartment  contents
  • Arterial flow compromised → ischemia → cell death → loss of function
    • Clinical manifestations
      • Early recognition and treatment essential
      • May occur initially or may be delayed several days
      • Ischemia can occur within 4 to 8 hours after onset
      • Six Ps
        • Pain
          • Out of proportion to the injury that is not managed by opioid analgesics and pain on passive stretch of muscle traveling through the compartment
        • Pressure
          • Increase in pressure in the compartment
        • Paresthesia
          • Numbness and tingling
        • Pallor
          • Coolness, and loss of normal color of the extremity
        • Paralysis
          • Loss of function
        • Pulselessness
          • Diminished or absent peripheral pulses
  • Interprofessional care
    • Prompt, accurate diagnosis via regular neurovascular assessments
      • Notify of pain unrelieved by drugs and out of proportion to injury
      • Paresthesia is also an early sign
    • Assess urine output  and kidney function
    • NO elevation above heart
    • NO ice
    • Surgical decompression (fasciotomy)
• Venous thromboembolism
  • High susceptibility aggravated by inactivity of muscles
  • Prophylactic anticoagulant drugs
  • Antiembolism stockings
  • Sequential compression devices
  • ROM exercises
• Fat embolism (FES)
  • Presence of systemic fat globules from fracture that are distributed into tissues and organs after a traumatic skeletal injury
  • Contributory factor in many deaths associated with fracture
  • Most common with fracture of long bones, ribs, tibia, and pelvis
  • Interprofessional care
    • Treatment is directed at prevention
    • Careful immobilization and handling of a long bone fracture probably the most important factor in prevention
    • Management is supportive and related to symptom management
    • Coughing and deep breathing
    • Administer O₂
    • Intubation/ intermittent positive pressure ventilation