Learning Center Articles

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