Complications of Fractures

Complications of the

fractures

Complications of the

fractures Submitted by :-

Amit Kochhar

B.O.T. 2nd year

Pt. D.D.U. I.P.H

Submitted by :-

Amit Kochhar

B.O.T. 2nd year

Pt. D.D.U. I.P.H

Complications From Fractures

Complications From Fractures

• Fracture is a common event: most of us will experience at least one during a lifetime.

• In modern times, with medical and surgical assistance, the majority heal without problem or significant loss of function.

• However, complications can pose risk to limb and even life.

• Fracture is a common event: most of us will experience at least one during a lifetime.

• In modern times, with medical and surgical assistance, the majority heal without problem or significant loss of function.

• However, complications can pose risk to limb and even life.

ClassificationClassification

• Complications of fractures tend to be classified according to whether they are local or systemic and when they occur –

Early Late

• Complications of fractures tend to be classified according to whether they are local or systemic and when they occur –

Early Late

Early complicationsEarly complications

• Early complications occur at the time of the fracture (immediate) or soon after.

• They are again classified into-Local Systemic

• Early local complications tend to affect mainly the soft tissues.

• Early complications occur at the time of the fracture (immediate) or soon after.

• They are again classified into-Local Systemic

• Early local complications tend to affect mainly the soft tissues.

Local Early complicationsLocal Early complications

• Vascular injury causing haemorrhage, internal or external

• Visceral injury causing damage to structures such as brain, lung or bladder

• Damage to surrounding tissue, nerves or skin

• Haemarthrosis • Compartment syndrome (or Volkmann's

ischaemia)

• Vascular injury causing haemorrhage, internal or external

• Visceral injury causing damage to structures such as brain, lung or bladder

• Damage to surrounding tissue, nerves or skin

• Haemarthrosis • Compartment syndrome (or Volkmann's

ischaemia)

• Wound Infection, more common for open fractures

• Tetanus

• Gas gangrene

• Injury to joints

• Wound Infection, more common for open fractures

• Tetanus

• Gas gangrene

• Injury to joints

Vascular injuryVascular injury

Visceral injuriesVisceral injuries

Nerve and skin tissue damage

Nerve and skin tissue damage

Open Humeral fracture with Radial Nerve Injury

HaemarthrosisHaemarthrosis

Bleeding in the joint because of fractureBleeding in the joint because of fracture

Compartment syndromeCompartment syndrome• Fractures of the limbs can cause severe

ischaemia, even without damage to a major blood vessel

• . Bleeding or oedema in an osteofascial compartment increases pressure within the compartment, reducing capillary flow and causing muscle ischaemia

• A vicious circle develops of further oedema and pressure build-up, leading swiftly to muscle and nerve necrosis.

• Limb amputation may be required if untreated.

• Fractures of the limbs can cause severe ischaemia, even without damage to a major blood vessel

• . Bleeding or oedema in an osteofascial compartment increases pressure within the compartment, reducing capillary flow and causing muscle ischaemia

• A vicious circle develops of further oedema and pressure build-up, leading swiftly to muscle and nerve necrosis.

• Limb amputation may be required if untreated.

• Compartment syndromes can also result from:

Crush injuries caused by falling debris or from a patient’s unconscious compression of their own limb.

Swelling of a limb inside an over-tight cast.

• Compartment syndromes can also result from:

Crush injuries caused by falling debris or from a patient’s unconscious compression of their own limb.

Swelling of a limb inside an over-tight cast.

• Compartment syndrome can occur in any compartment, e.g. the hand, forearm, upper arm, abdomen, buttock, thigh, and leg.

• 40% occur following fracture of the shaft of the tibia (with an incidence of 1-10%) and about 14% following fracture of a forearm bone.

• Risk is highest in those under 35 years.

• Compartment syndrome can occur in any compartment, e.g. the hand, forearm, upper arm, abdomen, buttock, thigh, and leg.

• 40% occur following fracture of the shaft of the tibia (with an incidence of 1-10%) and about 14% following fracture of a forearm bone.

• Risk is highest in those under 35 years.

• Compartmental syndrome may lead to the Volkmann's ischaemia:

• Compartmental syndrome may lead to the Volkmann's ischaemia:

• Presentation:- Signs of ischaemia (5 P's: Pain,

Paraesthesia, Pallor, Paralysis, Pulselessness)

Signs of raised intracompartmental pressure:

1. Swollen arm or leg

2. Tender muscle - calf or forearm pain on passive extension of digits

3. Pain out of proportion to injury

4. Redness, mottling and blisters Watch for signs of renal failure

• Presentation:- Signs of ischaemia (5 P's: Pain,

Paraesthesia, Pallor, Paralysis, Pulselessness)

Signs of raised intracompartmental pressure:

1. Swollen arm or leg

2. Tender muscle - calf or forearm pain on passive extension of digits

3. Pain out of proportion to injury

4. Redness, mottling and blisters Watch for signs of renal failure

• ManagementRemove/relieve external pressures

(fasciotomy)Prompt decompression of threatened

compartments by open fasciotomy Debride any muscle necrosis Treat hypovolaemic shock and oliguria

urgently Renal dialysis may be necessary

• ManagementRemove/relieve external pressures

(fasciotomy)Prompt decompression of threatened

compartments by open fasciotomy Debride any muscle necrosis Treat hypovolaemic shock and oliguria

urgently Renal dialysis may be necessary

Removal of extra pressure(fasciotomy)

Removal of extra pressure(fasciotomy)

• ComplicationsAcute renal failure secondary to

rhabdomyolysis DIC Volkmann's contracture (where infarcted

muscle is replaced by inelastic fibrous tissue)

• ComplicationsAcute renal failure secondary to

rhabdomyolysis DIC Volkmann's contracture (where infarcted

muscle is replaced by inelastic fibrous tissue)

Gas gangreneGas gangrene

• Clostidium welchii ( perfringens )

• Clinical presentation Subcutaneous crepitation Myonecrosis

• TreatmentDebridement Penicillin

• Clostidium welchii ( perfringens )

• Clinical presentation Subcutaneous crepitation Myonecrosis

• TreatmentDebridement Penicillin

tetanustetanus

• Causative agentClostidium tetaniRelease exotoxin

• SymptomsTRISMUSDYSPHAGIARISUS SARDONICUSOPIS THOTONAS

• Causative agentClostidium tetaniRelease exotoxin

• SymptomsTRISMUSDYSPHAGIARISUS SARDONICUSOPIS THOTONAS

• TreatmentImmunoglobulinBed rest and sedation Respiratory support Penicillin

• TreatmentImmunoglobulinBed rest and sedation Respiratory support Penicillin

Injury to jointsInjury to joints

AC joint injury after clavicle and scapular fracture

AC joint injury after clavicle and scapular fracture

Systemic early complicationsSystemic early complications

• Fat embolism • Shock • ARDS• Thromboembolism (pulmonary or

venous) • Exacerbation of underlying diseases

such as diabetes or CAD • Pneumonia

• Fat embolism • Shock • ARDS• Thromboembolism (pulmonary or

venous) • Exacerbation of underlying diseases

such as diabetes or CAD • Pneumonia

• Aseptic traumatic fever

• Septicaemia

• Crush syndrome

• Aseptic traumatic fever

• Septicaemia

• Crush syndrome

Fat embolismFat embolism• This is a relatively uncommon disorder that occurs

in the first few days following trauma with a mortality rate of 10-20%

• Fat drops are thought to be released mechanically from bone marrow following fracture, coalesce and form emboli in the pulmonary capillary beds and brain, with a secondary inflammatory cascade and platelet aggregation

• An alternative theory suggests that free fatty acids are released as chylomicrons following hormonal changes due to trauma or sepsis

• 5 Risk of Fat Embolism Syndrome (FES) increases with number of fractures, but is also seen following severe burns, CPR, bone marrow transplant and liposuction.6

• This is a relatively uncommon disorder that occurs in the first few days following trauma with a mortality rate of 10-20%

• Fat drops are thought to be released mechanically from bone marrow following fracture, coalesce and form emboli in the pulmonary capillary beds and brain, with a secondary inflammatory cascade and platelet aggregation

• An alternative theory suggests that free fatty acids are released as chylomicrons following hormonal changes due to trauma or sepsis

• 5 Risk of Fat Embolism Syndrome (FES) increases with number of fractures, but is also seen following severe burns, CPR, bone marrow transplant and liposuction.6

•Risk factorsClosed fractures Multiple fractures Pulmonary contusion Long bone/pelvis/rib fractures

•Risk factorsClosed fractures Multiple fractures Pulmonary contusion Long bone/pelvis/rib fractures

•Presentation• Sudden onset dyspnoea

• Hypoxia

• Fever

• Confusion, coma, convulsions • Transient red-brown petechial rash

affecting upper body, especially axilla

•Presentation• Sudden onset dyspnoea

• Hypoxia

• Fever

• Confusion, coma, convulsions • Transient red-brown petechial rash

affecting upper body, especially axilla

• Treatment :-Respiratory supportHeparinisationIntravenous low molecular weight

dextran(lomodex 20) and corticosteroids.

• Treatment :-Respiratory supportHeparinisationIntravenous low molecular weight

dextran(lomodex 20) and corticosteroids.

Hypovolaemic shockHypovolaemic shock

Bleeding after trauma Hypovolaemic ShockBleeding after trauma Hypovolaemic Shock

Acute respiratory distress syndrome

Acute respiratory distress syndrome

Deep vein thrombosisDeep vein thrombosis• Common complication associated with lower

limb injuries and with spinal injuries• D.V.T. proximal to the knee is a common cause of life threatening complication of Pulmonary embolism• Causes:-

Immobilization following traumaFracture of the leg

• Symptoms:-Leg swellingCalf tenderness

• Common complication associated with lower limb injuries and with spinal injuries

• D.V.T. proximal to the knee is a common cause of life threatening complication of Pulmonary embolism• Causes:-

Immobilization following traumaFracture of the leg

• Symptoms:-Leg swellingCalf tenderness

Leg swelling Leg swelling

Deep vein thrombosis Phlebogram:

a. Normal (right calf)

b. Thrombosis (left calf)

c. Femoral vein thrombosis

Deep vein thrombosis Phlebogram:

a. Normal (right calf)

b. Thrombosis (left calf)

c. Femoral vein thrombosis

• Consequences:- pulmonary embolism

TachypnoeaDyspnoea4-5 days after trauma

• Treatment:-Elevation of the limbAnti coagulating therapyRespiratory support and heparin

therapy{ respiratory embolism}Early internal fixation of flexorsActive mobilization of the extremity

• Consequences:- pulmonary embolism

TachypnoeaDyspnoea4-5 days after trauma

• Treatment:-Elevation of the limbAnti coagulating therapyRespiratory support and heparin

therapy{ respiratory embolism}Early internal fixation of flexorsActive mobilization of the extremity

pneumoniapneumonia

• Bed rest after fracture

and during surgery

can increase the

vulnerability

• Up to half of the patients

with significant chest

injuries develops pneumonia

• Bed rest after fracture

and during surgery

can increase the

vulnerability

• Up to half of the patients

with significant chest

injuries develops pneumonia

Aseptic traumatic feverAseptic traumatic fever

• Aseptic traumatic fever: This is supposed to be due to absorption of fibrin ferment taking place.

• It may, however, be due to some irritation, as of a badly fitting splint, and disappears on removal

• Aseptic traumatic fever: This is supposed to be due to absorption of fibrin ferment taking place.

• It may, however, be due to some irritation, as of a badly fitting splint, and disappears on removal

SepticaemiaSepticaemia

• Because of trauma a large amount of bacteria can enter in the blood stream and may cause septicemia

• Because of trauma a large amount of bacteria can enter in the blood stream and may cause septicemia

Symptoms Symptoms

• Management Initial Resuscitation - ABC

1. Secure airway

2. Support breathing

3. Restore circulation Fluid therapy Inotropic Support Antimicrobial therapy Respiratory Support

• Management Initial Resuscitation - ABC

1. Secure airway

2. Support breathing

3. Restore circulation Fluid therapy Inotropic Support Antimicrobial therapy Respiratory Support

Crush syndromeCrush syndrome

• Crushing injury to skeletal muscles because of the fracture

• Complications ShockRenal failure

• Crushing injury to skeletal muscles because of the fracture

• Complications ShockRenal failure

• ManagementTo avert disaster, a limb crushed severely

and for several hours should be amputated

• ManagementTo avert disaster, a limb crushed severely

and for several hours should be amputated

Crush injuryCrush injury

Late complicationsLate complications

• Late complications are those which occur after a substantial time has passed and are as a result of defective healing process or because of the treatment itself.

• They are again classified into two groups:Imperfect union of the fracture

others

• Late complications are those which occur after a substantial time has passed and are as a result of defective healing process or because of the treatment itself.

• They are again classified into two groups:Imperfect union of the fracture

others

Imperfect union of the fracture

Imperfect union of the fracture

• They are again classified into four sub groups:

Delayed union Non-union Mal-union Cross-union

• They are again classified into four sub groups:

Delayed union Non-union Mal-union Cross-union

Delayed unionDelayed union

• When a fracture takes more than the usual time to unite, it is said to have gone in delayed union

• Causes: Inadequate blood supply Infection Incorrect splintage

1. Insufficient splintage

2. Excessive traction

• When a fracture takes more than the usual time to unite, it is said to have gone in delayed union

• Causes: Inadequate blood supply Infection Incorrect splintage

1. Insufficient splintage

2. Excessive traction

Intact fellow bone: if one bone in the forearm or leg is unbroken, the fractured ends of the other may be held apart, end some delay then follows

Internal fixation: open reduction with internal fixation of a fracture delays union

• Signs:The fractured site is usually tenderThe bone may appear to move in one piece,

if however, it is subjected to stress , pain is immediately felt and the bone may angulate;

The fracture is not consolidated X-ray: the fractured site is still clearly visible,

but the bone ends are not sclerosed

Intact fellow bone: if one bone in the forearm or leg is unbroken, the fractured ends of the other may be held apart, end some delay then follows

Internal fixation: open reduction with internal fixation of a fracture delays union

• Signs:The fractured site is usually tenderThe bone may appear to move in one piece,

if however, it is subjected to stress , pain is immediately felt and the bone may angulate;

The fracture is not consolidated X-ray: the fractured site is still clearly visible,

but the bone ends are not sclerosed

• Treatment: Conservative:

1. Plaster should be sufficiently extensive and must fit accurately

2. Replace traction by plaster splintage

3. Use of functional bracing

Operative:1. If a fractured tibia is being held apart by a fibula

which was not fractured or which has united quickly, it is worth while excising 2.5 cm of fibula and reapplying plaster

• Treatment: Conservative:

1. Plaster should be sufficiently extensive and must fit accurately

2. Replace traction by plaster splintage

3. Use of functional bracing

Operative:1. If a fractured tibia is being held apart by a fibula

which was not fractured or which has united quickly, it is worth while excising 2.5 cm of fibula and reapplying plaster

Non-unionNon-union

• When the process of fracture healing comes to a stand before its completion, the fracture is said to have gone in non –union.

• It is not before six months that a fracture can be so labelled.

• When the process of fracture healing comes to a stand before its completion, the fracture is said to have gone in non –union.

• It is not before six months that a fracture can be so labelled.

• Causes : The injury

1. Soft tissue loss

2. Bone loss

3. Intact fellow bone

4. Soft tissue inter position

The bone1. Poor blood supply

2. Poor haematoma

3. Infection

4. Pathological lesion

• Causes : The injury

1. Soft tissue loss

2. Bone loss

3. Intact fellow bone

4. Soft tissue inter position

The bone1. Poor blood supply

2. Poor haematoma

3. Infection

4. Pathological lesion

The surgeon1.Distraction2.Poor splintage3.Poor fixation4.Impatience

The patient1.Immense2.Immoderate3.Immovable4.impossible

• Signs Movement can be elicited at the fracture site,

and this movement (unless excessive) is painless; such painless movement is diagnostic of non-union as distinct from delayed union

The surgeon1.Distraction2.Poor splintage3.Poor fixation4.Impatience

The patient1.Immense2.Immoderate3.Immovable4.impossible

• Signs Movement can be elicited at the fracture site,

and this movement (unless excessive) is painless; such painless movement is diagnostic of non-union as distinct from delayed union

X-ray:1. The fracture is visible and the bone on each side of

it may be sclerosed.

2. Two varieties of non-union can be distinguished :

I. Hypertrophic, with bulbous bone ends, indicating estrogenic activity (as if in the attempt to form bridging callus).

II. atrophic, with no calcification around the bone ends

X-ray:1. The fracture is visible and the bone on each side of

it may be sclerosed.

2. Two varieties of non-union can be distinguished :

I. Hypertrophic, with bulbous bone ends, indicating estrogenic activity (as if in the attempt to form bridging callus).

II. atrophic, with no calcification around the bone ends

• Treatment Conservative:

1. Occasionally symptom less, needing no treatment

2. Functional bracing may be sufficient to induce union

3. Electrical stimulation promotes osteogenesis

Operative1. Very rigid internal fixation with hypertrophic

non-union

2. Fixation with bone graft is needed in case of atrophic non union

• Treatment Conservative:

1. Occasionally symptom less, needing no treatment

2. Functional bracing may be sufficient to induce union

3. Electrical stimulation promotes osteogenesis

Operative1. Very rigid internal fixation with hypertrophic

non-union

2. Fixation with bone graft is needed in case of atrophic non union

Mal-unionMal-union

• Causes Primary

1. The fracture was never reduced and has united in a deformed position.

2. Shortening is, of course, one type of deformity.

Secondary 1. The fracture was reduced but the reduction was

not held.

2. Redisplacement may occur during the first week, and a check x-ray at 1 week is advisable.

• Causes Primary

1. The fracture was never reduced and has united in a deformed position.

2. Shortening is, of course, one type of deformity.

Secondary 1. The fracture was reduced but the reduction was

not held.

2. Redisplacement may occur during the first week, and a check x-ray at 1 week is advisable.

• Signs:The deformity is usually obvious.There may be painful limitation of joint

movementsAt elbow, valgus deformity may present

with delayed ulnar palsy

• Signs:The deformity is usually obvious.There may be painful limitation of joint

movementsAt elbow, valgus deformity may present

with delayed ulnar palsy

• Treatment: Conservative

1. If shortening is the main feature a raised shoe is usually sufficient

2. In child usually no treatment is required because it is expected to correct by remodelling

Operative1. Osteotomy

2. Excision of protruding bone

3. Osteoclasis

4. Redoing the fracture surgically

• Treatment: Conservative

1. If shortening is the main feature a raised shoe is usually sufficient

2. In child usually no treatment is required because it is expected to correct by remodelling

Operative1. Osteotomy

2. Excision of protruding bone

3. Osteoclasis

4. Redoing the fracture surgically

Cross unionCross union

• Sometimes radio-ulnar and tibio-fibular fractures may undergo cross-union

• Sometimes radio-ulnar and tibio-fibular fractures may undergo cross-union

Other late complicationsOther late complications

• Avascular necrosis• Shortening• Joint stiffness• Sudeck’s dystrophy• Osteomyelitis• Volkmann’s Ischaemic contracture• Myositis ossificans• Osteoarthritis

• Avascular necrosis• Shortening• Joint stiffness• Sudeck’s dystrophy• Osteomyelitis• Volkmann’s Ischaemic contracture• Myositis ossificans• Osteoarthritis

Avascular necrosisAvascular necrosis

• Blood supply of some bones is such that the vascularity of a part of it is seriously jeopardized following fracture, resulting in necrosis of the part.

• Blood supply of some bones is such that the vascularity of a part of it is seriously jeopardized following fracture, resulting in necrosis of the part.

Site Cause

Head of the femur

Fracture neck of the femur.

Posterior dislocation of the hip

Proximal pole of scaphoid

Fracture through the waist of the scaphoid

Body of the talus Fracture through neck of the talus

• Consequences:-

Avascular necrosis causes deformation of the bone. This leads, a few years later, to secondary osteoarthritis and causes painful limitation of joint movement.

• Consequences:-

Avascular necrosis causes deformation of the bone. This leads, a few years later, to secondary osteoarthritis and causes painful limitation of joint movement.

• Diagnosis:- X-ray changes:-

1. Sclerosis of the necrotic area

2. Deformity of the bone

3. Osteoarthritis

Bone scan:- changes can be seen before X-ray changes:

1. Visible as cold area on the bone

• Diagnosis:- X-ray changes:-

1. Sclerosis of the necrotic area

2. Deformity of the bone

3. Osteoarthritis

Bone scan:- changes can be seen before X-ray changes:

1. Visible as cold area on the bone

Avascular necrosis of the head of the femur

(Bone scan)Avascular necrosis of the head of the femur

(Bone scan)

• Treatment:- Avascular necrosis can be prevented by early, energetic reduction of susceptible fractures and dislocations. Treatment options:

1. Delay weight bearing till revascularization to prevent collapse

2. Revascularization

3. Excision of the avascular segment

4. Total joint replacement

• Treatment:- Avascular necrosis can be prevented by early, energetic reduction of susceptible fractures and dislocations. Treatment options:

1. Delay weight bearing till revascularization to prevent collapse

2. Revascularization

3. Excision of the avascular segment

4. Total joint replacement

Shortening Shortening

• It is a common complications of fractures and results from:-

1. Mal union of the long bones

2. Crushing: Actual bone loss

3. Growth defects: growth plate

or epiphyseal injuries

• It is a common complications of fractures and results from:-

1. Mal union of the long bones

2. Crushing: Actual bone loss

3. Growth defects: growth plate

or epiphyseal injuries

• Treatment:- Shortening of upper limbs goes unnoticed For lower limb treatment depends upon the

amount of shortening:1. Shortening less than 2 cm: compensated by shoe

raise

2. Shortening more than 2 cm: limb length equalization procedures

• Treatment:- Shortening of upper limbs goes unnoticed For lower limb treatment depends upon the

amount of shortening:1. Shortening less than 2 cm: compensated by shoe

raise

2. Shortening more than 2 cm: limb length equalization procedures

Joint stiffnessJoint stiffness

• It is a common complications of fracture treatment.

• Shoulder, elbow and knee joints are particularly prone to stiffness following immobilization

• It is a common complications of fracture treatment.

• Shoulder, elbow and knee joints are particularly prone to stiffness following immobilization

• Causes:- Intra-articular or Para-articular adhesions

secondary to immobilizations Contracture of the muscles around a joint

because of prolonged immobilizations Tethering of muscles at fracture site Myositis ossificans

• Consequences:- Hampers the normal physical activity Results in late osteoarthritis

• Causes:- Intra-articular or Para-articular adhesions

secondary to immobilizations Contracture of the muscles around a joint

because of prolonged immobilizations Tethering of muscles at fracture site Myositis ossificans

• Consequences:- Hampers the normal physical activity Results in late osteoarthritis

• Treatment:-Heat therapy and exercise

• Treatment:-Heat therapy and exercise

Manipulation of the joint under anesthesia

Surgical interventions1. To excise an extra articular bone block

2. To lengthen contracted muscles

3. Joint replacement, if there is pain due to secondary arthritis

Manipulation of the joint under anesthesia

Surgical interventions1. To excise an extra articular bone block

2. To lengthen contracted muscles

3. Joint replacement, if there is pain due to secondary arthritis

Sudeck’s dystrophy Sudeck’s dystrophy

• Also known as Reflex Sympathetic Dystrophy.

• Involves a disturbance in the sympathetic nervous system.

• Consequences:-PainHyperaesthesiaTenderness Swelling

• Also known as Reflex Sympathetic Dystrophy.

• Involves a disturbance in the sympathetic nervous system.

• Consequences:-PainHyperaesthesiaTenderness Swelling

Skin become red, shiny and warm in early stages

Progressive atrophy of the skin, muscles and nails in later stages

Joint deformity and stiffness ensuesX-ray shows characteristic spotty rarefaction

Bone scan

Skin become red, shiny and warm in early stages

Progressive atrophy of the skin, muscles and nails in later stages

Joint deformity and stiffness ensuesX-ray shows characteristic spotty rarefaction

Bone scan

• Treatment:-Occupational therapy and physiotherapy

constitutes the principle modality of treatment.

Further trauma in the form of an operation or forceful mobilizations is injurious.

Use of β-blocker.In resistant cases, sympathetic blocks have

been shown to aid in recovery.

• Treatment:-Occupational therapy and physiotherapy

constitutes the principle modality of treatment.

Further trauma in the form of an operation or forceful mobilizations is injurious.

Use of β-blocker.In resistant cases, sympathetic blocks have

been shown to aid in recovery.

Osteomyelitis Osteomyelitis

• Osteomyelitis is an infection of a bone.

• Many different types of bacteria can cause osteomyelitis.

• However, infection with a bacterium called Staph. aureus is the most common cause. Infection with a fungus is a rare cause.

• Osteomyelitis is an infection of a bone.

• Many different types of bacteria can cause osteomyelitis.

• However, infection with a bacterium called Staph. aureus is the most common cause. Infection with a fungus is a rare cause.

• After operative treatment of fracture bacteria may spread to the bone and may cause osteomyelitis.

• Treatment:- Antibiotics Surgery:

1. in case of abscess formation

2. The infection presses on other important structures

3. The infection has become 'chronic' (persistent) and some bone has been destroyed.

4. Hyperbaric oxygen

• After operative treatment of fracture bacteria may spread to the bone and may cause osteomyelitis.

• Treatment:- Antibiotics Surgery:

1. in case of abscess formation

2. The infection presses on other important structures

3. The infection has become 'chronic' (persistent) and some bone has been destroyed.

4. Hyperbaric oxygen

Volkmann’s ischaemic contracture

Volkmann’s ischaemic contracture

• This a sequel to Volkmann's ischaemia.

• The ischaemic muscles are replaced by fibrous tissue

• If the peripheral nerves are also affected, sensory or motor paralysis may happen

• This a sequel to Volkmann's ischaemia.

• The ischaemic muscles are replaced by fibrous tissue

• If the peripheral nerves are also affected, sensory or motor paralysis may happen

• Clinical features:-Marked atrophySkin becomes dry and scalyFlexion deformityNails shows atrophic changes

• Clinical features:-Marked atrophySkin becomes dry and scalyFlexion deformityNails shows atrophic changes

• Treatment:-Mild deformity can be corrected by passive

stretching using a turn-buckle splint (Volkmann's splint)

For moderate deformities, a soft tissue sliding operation, where the flexor muscles are released from their origin, is performed

For a severe deformity, bone shortening operations may be required

• Treatment:-Mild deformity can be corrected by passive

stretching using a turn-buckle splint (Volkmann's splint)

For moderate deformities, a soft tissue sliding operation, where the flexor muscles are released from their origin, is performed

For a severe deformity, bone shortening operations may be required

Myositis ossificansMyositis ossificans

• Myositis ossificans is where calcifications and bony masses develop within muscle and can occur as a complication of fractures.

• It may also happens because of the ossification of the hematoma around a joint after a compound fracture.

• Myositis ossificans is where calcifications and bony masses develop within muscle and can occur as a complication of fractures.

• It may also happens because of the ossification of the hematoma around a joint after a compound fracture.

• Clinical features:-Pain , Tenderness , Focal swelling, and Joint/muscle contractions

• Treatment:-Massage following injury is strictly prohibited.In early stages rest is advisedNSAIDS may help to reduce pain

• Clinical features:-Pain , Tenderness , Focal swelling, and Joint/muscle contractions

• Treatment:-Massage following injury is strictly prohibited.In early stages rest is advisedNSAIDS may help to reduce pain

In late stages Occupational and Physiotherapy is prescribed to regain movements

Ultra soundIn some cases surgical excision of myositic

mass is done

In late stages Occupational and Physiotherapy is prescribed to regain movements

Ultra soundIn some cases surgical excision of myositic

mass is done

osteoarthritisosteoarthritis

• Osteoarthritis is liable to follow malunion and traumatic injuries to the joints.

• Joint surfaces become incongruent

• Direction of stress transmission is abnormal

• Increase wear and tear at the joint

• Osteoarthritis is liable to follow malunion and traumatic injuries to the joints.

• Joint surfaces become incongruent

• Direction of stress transmission is abnormal

• Increase wear and tear at the joint

• Treatment:- Osteoarthritis cannot be cured,

but it can be treated

The goal of every treatment for arthritis is to:-1. reduce pain and stiffness,

2. allow for greater movement, and

3. slow the progression of the disease

Anti-Inflammatory Medications

• Treatment:- Osteoarthritis cannot be cured,

but it can be treated

The goal of every treatment for arthritis is to:-1. reduce pain and stiffness,

2. allow for greater movement, and

3. slow the progression of the disease

Anti-Inflammatory Medications

Cortisone Injections Occupational and physiotherapy Weight Loss Activity ModificationDiet: obesity is a risk factor for developing

osteoarthritis

Cortisone Injections Occupational and physiotherapy Weight Loss Activity ModificationDiet: obesity is a risk factor for developing

osteoarthritis

References References

• Apley’s system of orthopaedics and fractures- A. Graham Apley

Louis Solomon

• Essential orthopaedics- J. Maheshwari

• Adam’s outline of orthopaedics

• http://www.patient.co.uk/showdoc/40001214/

• Google search

• Apley’s system of orthopaedics and fractures- A. Graham Apley

Louis Solomon

• Essential orthopaedics- J. Maheshwari

• Adam’s outline of orthopaedics

• http://www.patient.co.uk/showdoc/40001214/

• Google search