1. Complications of fractures

2. I. general complications:
5/20/2018
I. general complications:
Blood loss.
Shock.
diffuse coagulopathy .
respiratory dysfunction.
metabolic response.

3. tetanus.
gas gangrene.
fat embolism.

4. Crush syndrome. (if bulk muscle is crushed it is reflected on the kidney function ,end with renal failure.)
Venous thrombosis &pulmonary embolism.
In veins of the calf and less in the thigh.

5. II Local complications
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II Local complications
A:early .
( bone ,soft tissue).
B:late.
(bone ,soft tissue,joint).

6. Early complications bone
5/20/2018
Early complications bone
Infection particularly in compound fracture.

7. 5/20/2018
Soft tissue
complications

8. Vascular injury.
Brachial artery.
Popliteal artery.

9. Nerve injury.
(neuropraxia, axonotemesis, neurotemesis).

10. Posterior interosseous
nerve
Injury
Axillary
Shoulder dislocation
Radial
Fracture humerus shaft
Radial or median
Supracondylar humerus
Ulnar
Medial epicondyle
Posterior interosseous
Monteggia fracture dislocation
Sciatic
Hip dislocation

11. Visceral injury.
diaphragm (in fracture pelvis).

12. 5/20/2018
Compartment syndrome.
Fracture of the arm or the leg can give rise to severe ischaemia even if there is no damage to a major vessel.
this lead to reduce in the capillary flow.

13. Increase the interistial pressure
Bleeding,edema,
inflammation
5/20/2018
Increase the interistial pressure
Within osteofascial
Compartment > 40mm
Greater pressure
&greater ischaemia
Further
edema
Reduce in capillary
flow
Muscle
ischaemia

16. (VOLKMANNS’ ischaemia contractures)
5/20/2018
After 12 hours or less necrosis of the nerve,which is capable for regeneration.
But muscle once infract can never recovers and is replaced by inelastic fibrous tissue
(VOLKMANNS’ ischaemia contractures)

18. Clinical features Five Ps. Pain with sever swelling . Parasthesia.
5/20/2018
Clinical features
Five Ps.
Pain with sever swelling .
Parasthesia.
Pallor.
Paralysis.
Pulse less.

19. Treatment Removal cast bandage. Fasciotomy >40 mm Hg.
5/20/2018
Treatment
Removal cast bandage.
Fasciotomy >40 mm Hg.
<40 mmHg close observation.
The wound should be left open and inspected 5 days late to be suture or skin graft.

22. Fracture blisters occurred by edema.
Plaster sores.
Torn muscle fibers.

23. Haemarthrosis.
Gas gangrene with clostridium M.O. in a dirty wound

24. Late complications bone
5/20/2018
Late complications bone
avascular necrosis:
Due to ischaemia after injury.as fracture neck femur.

26. Delayed union: 1.inadequate blood supply. 2.infection.
3.incorrect splintage.
4.intact fellow bone (as in fracture tibia and fibula).

27. Non union: 1.too large gap. 2.Soft tissue interposition.
5/20/2018
Non union:
1.too large gap.
2.Soft tissue interposition.
3.Intra articular fractures(scaphoid).

30. Mal union:
When the fragments join in an unsatisfactory position.

31. Growth disturbance
damage to the physis may lead to abnormal or arrested growth.

34. Late soft tissue complications
5/20/2018
Late soft tissue complications
Myositis ossificans
(heterotopic ossification in muscle as after elbow injury ).
Bed sores

35. Tendinitis:
(tibilalis posterior in ankle fracture).
Tendon rupture:
(extensor pollicis longus in colles).

36. Nerve compression:
as in radial palsy followed faulty use of crutches.
Nerve entrapment:
( median nerve following injuries around wrist).

37. Volkmann's’ contracture

39. Late joints complication
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Late joints complication
Sudecks’ atrophy.
(painful osteoporosis of the hand ,
reflex sympathetic dystrophy ).

40. Osteoarthritis.
(fracture involving a joint may severely damage the articular cartilage).

41. Instability .
(muscle weakness, gun shot with bone loss, recurrent dislocation)
Joint stiffness.
due to oedema and fibrosis of the capsule.

42. Pathological fracture

43. Osteogesis imperfecta. Pagets’ disease. Chronic infection.
5/20/2018
Osteogesis imperfecta.
Pagets’ disease.
Chronic infection.
Solitary bone cyst.

46. Aneurysmal bone cyst.
Osteosarcoma.
Ewing's sarcoma.
Metastatic tumors

47. Clinical features of pathological
5/20/2018
Clinical features of pathological
Fracture develop spontaneously or after trivial injury.

48. Examinations:
general &Local.

49. Investigations:
x-ray,
blood,
urine,
scanning,
biopsy.

52. Treatment : Underlying pathology ,
and fixation with bone cement and internal fixation.