Fracture compli & mx
-
Upload
orthoprince -
Category
Health & Medicine
-
view
869 -
download
0
description
Transcript of Fracture compli & mx
![Page 1: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/1.jpg)
Fractures – Complications & Management
![Page 2: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/2.jpg)
Complication of Fractures Immediate Complication (at the
time of fracture) Early complication (initial few
days) Late Complication
![Page 3: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/3.jpg)
Immediate Complications
Systemic Hypovolaemic ShockLocal Injury to major vessels Injury to muscles & tendons Injury to joints Injury to viscera
![Page 4: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/4.jpg)
Early complications
Systemic Hypovolaemic shock ARDS Fat Embolism Syndrome DVT & Pulmonary embolism Aseptic traumatic fever Septicemia (Open fractures) Crush syndrome
![Page 5: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/5.jpg)
Early Complications
Local Infection Compartmental Syndrome
![Page 6: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/6.jpg)
Late complications
Bone Union related Delayed-Union Non-union Mal-union Cross-union
![Page 7: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/7.jpg)
Late complications
Others Avascular
Necrosis Shortening Joint Stiffness Sudeck’s
dystrophy (Reflex Sympathetic dystrophy)
Osteomyelitis Ischaemic
contracture Myossitis
Ossificans Osteoarthritis
![Page 8: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/8.jpg)
Hypovolaemic Shock Commonest cause for death Pelvis(2 lts) & Long Bone(1.5lts)
#’s External Hemorrhage eg: Open fracture, vascular Injury Internal Hemorrhage eg: Chest/Abdominal bleeding
![Page 9: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/9.jpg)
Hypovolaemic shock-Management Follow the BLS/ATLS protocolsEg: No 14 IV cannula + 2lts of
crystalloids/colloids/blood, Localize the site of bleeding, needle aspiration, Inv - X-ray, Ultrasound
Avoid movements at the Fracture Stabilize the fracture eg : External
Fixator for Pelvis, Splints for long bones
![Page 10: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/10.jpg)
ARDS –Adult Respiratory Distress Syndrome
Cause – Trauma & Shock Release of Inflammatory mediators Disruption of Pulmonary
microvasculature Onset in 24 hrs Tachypnoea & laboured breathing
![Page 11: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/11.jpg)
ARDS - Management Chest X-ray: diffuse Pulm infiltrate Arterial PO2 <50 100% Oxygen Assisted ventilation Chest clears in 4 to 7 days Not treated – CardioPulmonary
failure - Death
![Page 12: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/12.jpg)
Fat Embolism Occlusion of Small vessels by fat
globules Bone Marrow/Adipose tissue Polytrauma of long major bones Release of free fatty acids(Lipases
action) – toxic vasculitis – Platelet fibrin thrombosis
Obstruction of Pulm vessels by fat
![Page 13: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/13.jpg)
Fat Embolism – clinical features
Develops in 24 to 72hrs Cerebral type – drowsy, restless,
disoriented, coma Pulmonary type – tachypnoea,
tachycardia Patechial rash- neck, axillary fold, chest,
conjunctiva
Respiratory failure - Death
![Page 14: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/14.jpg)
Fat Embolism - Diagnosis Strong suspicion Retinal artery emboli (Striate
haemorrhages)
Fat globules in sputum & Urine X-ray – Patchy pulm Infiltrate (snow
storm)
Blood PO2 <50
![Page 15: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/15.jpg)
Fat Embolism - treatment Respiratory support Heparinisation, IV Low molecular
wt dextran, corticosteriods
![Page 16: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/16.jpg)
Deep Vein Thrombosis (DVT)& Pulmonary Embolism (PE)
Lower limb & Spinal Injuries Cause: Immobilization – venous
stasis – thrombosis of veins DVT proximal to knee is Dangerous DVT in 48 hrs – PE in 4 to 5 days
![Page 17: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/17.jpg)
DVT & PE – Clinical Feature High index of suspicion Elderly & Obese pts Leg swelling & calf tenderness Calf tenderness on passive
dorsiflexion of Ankle ( Homan’s sign) Venography/Doppler Ultrasound PE – tachypnoea, dyspnoea, chest
pain, hemoptysis
![Page 18: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/18.jpg)
DVT & PE - treatment DVT : Elevation of limb, Elastic
bandage, active mobilization after early fracture stabilization, anticoagulation
PE : Respiratory support, Anticoagulation therapy
![Page 19: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/19.jpg)
Crush syndrome Massive crushing of Muscles Release of Myohaemoglobin Precipitates in Renal tubules Acute renal tubular necrosis Treated as for Acute renal failure
![Page 20: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/20.jpg)
Injury to the blood vessels Femoral - # L/3rd Femur Popliteal – Supracondylar # Femur(commenest)
Post Tibial – Dislocation Knee, # Tibia Subclavian – Clavicle # Axillary – Fracture dislocation shoulder Brachial – Supracondylar # Humerus
![Page 21: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/21.jpg)
Injury to the blood vessels No effect – collateral circulation is
good Exercise Ischemia – vascular
claudiction Ischemic contracture – Ischemic
muscle necrosis – contracture/fibrosis – volkmann’s ischemic contracture
Gangrene
![Page 22: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/22.jpg)
Injury to the blood vessels Pain – cramp like Pulse – absent Pallor Paraesthesia ParalysisDoppler study / AngiogramRepair of vessel
![Page 23: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/23.jpg)
Injury to NervesInjury to Tendons
![Page 24: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/24.jpg)
Injury to Joints Subluxation or Dislocation Early reduction & stabilization Early Joint movement Secondary Osteoarthritis/stiffness
![Page 25: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/25.jpg)
Infection - Osteomyelitis Open #’s (Common)
![Page 26: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/26.jpg)
Compartment syndrome Rise in Pressure in closed
compartment of the limb Jeopardize the Muscle & nerve
blood supplyInjury & oedma to musclesFracture hematomaIschemia leading to muscle oedema
![Page 27: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/27.jpg)
Compartment syndrome- Vicious cycle
swelling
Blood supply Muscle Ischemia
Injury
![Page 28: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/28.jpg)
Compartment syndrome - Results
Ischemic Muscle necrosis Muscle fibrosis – Contractures Nerve damage Motor sensory loss Gangrene
![Page 29: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/29.jpg)
Compartmental syndrome - Diagnosis
Excessive Pain High risk injuries eg:Supracondylar # humerus, Forearm bones #, Closed Tibial #, Crush injuries to leg & forearm
![Page 30: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/30.jpg)
Compartmental syndrome - Diagnosis
Stretch test – earliest sign Tense compartment Hypoaesthesia of involved nerves Muscle weakness Compartmental pressure of >40
mm of H2O
![Page 31: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/31.jpg)
Compartmental syndrome - Treatment
Early prevention – limb elevation, active finger mobilization
Early surgical decompression eg: fasciotomy
![Page 32: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/32.jpg)
Delayed & Non-union More than the usual time to unite Fracture healing has stopped (not
before six months)
![Page 33: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/33.jpg)
Delayed & Non-union Causes related to the patients Age – common in old age Asso Systemic illness
eg:Malignancy, Osteomalacia
![Page 34: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/34.jpg)
Delayed & Non-union Causes related to fracture Distraction at fracture site Muscle pulling eg:Patella &
Olecranon #Gravity eg: # shaft of humerus Soft tissue interposition eg: # shaft
humerus, femur Bone loss at the # site
![Page 35: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/35.jpg)
Non-union
![Page 36: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/36.jpg)
Delayed & Non-union Causes related to fracture Infection from open # Damage/Poor blood supply eg:#
neck of femur, L/3rd Tibia Pathological #
![Page 37: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/37.jpg)
Delayed & Non-union Causes related to Treatment Inadequate redution Inadequate immobilization Distration during treatment
![Page 38: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/38.jpg)
Types of Nonunion Atrophic Hypertrophic
Common sitesNeck of femur, Scaphoid, L/3rd Tibia,
Lateral condyle Humerus
![Page 39: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/39.jpg)
Delayed & Non-union : C/f Persistant Pain Pain on stressing the # Mobility (Nonunion) Increasing deformity
![Page 40: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/40.jpg)
Delayed & Non-union – X-ray Fracture line is visible Inadequate bridging callus
(Delayed) No bridging callus (Non-union)
TomogramMedullary venography
![Page 41: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/41.jpg)
Infected Nonunion
![Page 42: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/42.jpg)
Delayed & Non-union- Treatment Bone Grafting BG + Internal Fixation Excision of fragment eg: # neck of
femur in elderly(hemiarthroplasty) Ilizarov’s method
![Page 43: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/43.jpg)
Malunion # unites in improper position Disability of clinical significance eg:
deformity, shortening, limitation of motion
Improper treatment Commonest eg: colles #, Clavicle
#
![Page 44: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/44.jpg)
Malunion
![Page 45: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/45.jpg)
Malunion - Treatment Osteoclasis Corrective osteotomy No treatment – RemodellingChildren, 5 to 10 deg of Angulation, Angulation in the plane of movement, #’s near joints
![Page 46: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/46.jpg)
Avascular Necrosis Blood supply is jeopardized Head of Femur eg: # neck of
femur, dislocation hip Proximal pole of scaphoid, Body of
Talus
![Page 47: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/47.jpg)
Avascular Necrosis Sclerosis of necrotic bone Deformity due to collapse Osteoarthritis
![Page 48: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/48.jpg)
Avascular Necrosis- Treatment Delayed wt bearing Vascularised bone graft Excision of avascular segment Excision & Arthroplasty
![Page 49: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/49.jpg)
Reflex sympathetic Dystrophy (sudeck’s Dystrophy) Following Trauma Pain Hyperaesthesia Tenderness & Swelling Skin is red, shiny, warm Atrophy of skin, muscle, nail Joint deformity & stiffness
![Page 50: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/50.jpg)
Reflex sympathetic Dystrophy (sudeck’s Dystrophy) X-ray – Spotty rarefaction Physiotherapy Avoid surgery or forceful
mobilization Sympathetic blocks
![Page 51: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/51.jpg)
Myossitis Ossificans (post-traumatic ossification) Ossification of the hematoma Joint stiffness Head injury Children around elbow Massage
![Page 52: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/52.jpg)
Myossitis Ossificans (post-traumatic ossification) X-ray-active myositis – margins are
fluffy Mature myositis – bone
trabeculated, well defined margins
![Page 53: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/53.jpg)
Myossitis Ossificans (post-traumatic ossification) Avoid Massage Rest to the limb Surgical excision of mature
myositis
![Page 54: Fracture compli & mx](https://reader034.fdocuments.net/reader034/viewer/2022051412/54b7dd714a7959466a8b45dd/html5/thumbnails/54.jpg)
Thankyou
Dr Jai Thilak
Orthopaedics