Complications of Fracture

FRACTURE
Injury of the extremity (long
bone) whether caused by
penetrating or blunt trauma as
high risk for fracture
complications

COMPARTMENT
SYNDROME

begins with: contusion and hemorrhage

within a space defined & limited by a
fascia envelope produce an increased
interstitial tissue pressures

intracompartmental structures cannot

withstand the infinite pressure

introduction of excess fluid of extraneous

constriction increases pressure & reduces
tissue perfusion (until no O2 is available for
cellular metabolism)

elevated perfusion pressure occurs in

response to rising intracompartmental
pressure

autoregulatory mechanisms are overwhelmed

and a cascade of injury develops

capillaries collapse when venous pressure

is higher than capillary perfusion pressure

blood flow to capillaries stops

End result: loss of extremity, RENAL FAILURE
(if condition becomes severe and left untreated), or
loss of LIFE
in the absence of flow, O2 delivery stops

hypoxic injury causes cells to release vasoactive

substances (e.g., histamines, serotonin)
endothelial permeability increases
nerve conduction slows, tissue pH falls
due to anaerobic metabolism, surrounding
tissue suffers further damage, and muscle
tissue suffers necrosis, releasing myoglobin

capillaries allow continued fluid loss,

which increases tissue pressure and advances injury
Continued…
FRACTURE
Injury of the extremity (long bone)
whether caused by penetrating or
blunt trauma as high risk for fracture
complications

FAT EMBOLISM

3 Postulates:

Mechanical theory Hormonal response Metabolic response

after mechanical trauma pressure catecholamine & corticosteroid are fat droplets arise within circulated
in long bones that have high fat released as response to stress blood as a result of metabolic
content is elevated response to injury

act on serum lipids to mobilize

the veins within the bones are tissue stores of fats that act as stability of body’s emulsified fat
prevented from collapsing because emboli after their release into the (neutral triglycerides &
they adhere to the bony framework circulation phospholipids) is lost

fat droplets are forced into the small fat particles coalesce and
bloodstream through the open veins form microglobules

fat droplets/fat fat droplets/fat fat droplets/fat fat droplets/fat fat droplets/fat
globules travel globules may be globules may be globules may globules may be
through dislodged in the dislodged in the occlude dislodged in the
arteriovenous shunts blood vessels to the blood vessels to the PULMONARY blood vessels
to the BRAIN HEPATIC area RENAL structure circulation supplying the
HEART

produces local local ischemia and local ischemia and parenchymal

ischemia and inflammation inflammation damage and MYOCARDIAL
inflammation [(+) increased INFARCTION
decreased cerebral
pulmonary vascular
blood flow]
LIVER FAILURE acute tubular resistance
ensues if severe and necrosis CARDIOGENIC
untreated edema and SHOCK
NEUROGENIC
SHOCK hemorrhage in the
RENAL FAILURE alveoli reduced venous
return
Manifestations: impairs O2 transport
 mental status Manifestation: leading to hypoxia
changes  (+) free fat in reduced stroke
varying from the urine volume
headache and (emboli are
filtered by
ABG alteration,
mild agitation decreased cardiac
renal tubules) early respiratory
to delirium output
and coma
alkalosis then later
as acidosis,
“snowstorm
infiltrate” as shown
by CXR

ACUTE
PULMONARY
EDEMA, ACUTE
RESPIRATORY
DISTRESS
SYNDROME, and
HEART FAILURE
may ensue without
prompt, definitive
management
Continued…

FRACTURE

Injury of the extremity (long bone)

whether caused by penetrating or
blunt trauma as high risk for fracture
complications

SHOCK

AND/OR
traumatic damage to a large artery or vein that supplies due to trauma, patient may form a pseudoaneurysm (a
blood hole in an artery that is a contained hematoma)

hemorrhage (both visible and nonvisible blood loss) gets bigger and bigger
and loss of intravascular volume into the interstitial
space

ruptures

causes delayed hemorrhage

when initial clot lyses in about 48 hours, patient may

start to bleed severely

HYPOVOLEMIC
SHOCK
Continued…

FRACTURE

AVASCULAR REACTION TO DELAYED COMPLICATIONS

NECROSIS INTERNAL
FIXATION
DEVICES
 DELAYED MALUNION NONUNION
UNION
due to fracture, due to:
especially of a. mechanical
femoral neck failure associated with: factors: factors:
(inadequate a. distraction >infection at fracture >infection at
insertion and (pulling site fracture site
disruption of blood stabilization) apart) of
supply b. material bone >interposition of >interposition of
failure (faulty fragments tissue between bone tissue between bone
or damaged b. systemic ends ends
bone loses its blood device) or local
supply and c. corrosion of infection >inadequate >inadequate
eventually dies the device, c. poor immobilization or immobilization or
causing local nutrition manipulation that manipulation that
inflammation d. comorbidi disrupts callus disrupts callus
the devitalized bone d. allergic ty (e.g., formation formation
may collapse or response to DM,
reabsorb the metallic autoimmu >excessive space b/n >excessive space
alloy used ne bone fragments b/n bone fragments
e. osteoporotic disease) (bone gap) (bone gap)
Manifestations: remodeling
 X-rays show adjacent to >limited bone >limited bone
loss of the fixation healing does not contact contact
mineralized device (in w/c occur at a normal
matrix and stress needed rate for the >impaired blood >impaired blood
structural for bone location and type supply resulting in supply resulting in
collapse strength is of fracture AVN AVN
 patient transferred to
develops the device,
pain and causing a (+) fracture failure of the ends of commonly occurs
experiences disuse eventually the fractured bone to with fractures of
limited osteoporosis) heals… unite in a normal middle third of
movement alignment humerus, lower
third of tibia, and
pain and decreased neck of femur in
Interventions: function as prime patient complains of the elderly
 revitalization indicators persistent discomfort
with bone and abnormal
grafts, movement at fracture fibrocartilage or
prosthetic if the device is site fibrous tissue exists
replacement, removed, the bone between bone
or needs to be protected fragments; no bone
arthrodesis from: salts deposited
(joint fusion)  refracture
related to
osteoporosis, a false joint
 altered bone (pseudoarthrosis)
structure, often develops at
 and trauma fracture site

bone remodeling
reestablishes bone’s
structural strength
 - - FIN - -

Prepared by:

CERIACO, Chedan
Saint Louis University – College of Nursing, Baguio City
BSN III

References:

Brunner & Suddarth’s Textbook of Medical-Surgical Nursing-11th edition by Suzanne C. Smeltzer (et. al.)

www.emedicine.com