Complications of Fractures
Fracture complications range from immediate haemorrhage, neurovascular injury and compartment syndrome to later infection, venous thromboembolism and failure of union; serial assessment and rapid specialist escalation are the safety-critical skills.
Definition
Fracture complications are harms arising from the injury, its soft-tissue damage, immobilisation, surgery or failure of healing. Important early complications include haemorrhage, neurovascular injury, compartment syndrome, open-fracture or fixation-related infection, fat embolism and venous thromboembolism; later complications include delayed union, non-union, malunion, avascular necrosis, growth disturbance and post-traumatic arthritis.
First principles
Treat the injury and its complications as a changing process
A fracture can damage vessels, nerves and soft tissue at the moment of injury, while bleeding, oedema, immobilisation and fixation create later risks. Repeat the clinical assessment after realignment, splinting, surgery and any change in pain or neurology; a normal first examination does not make a deteriorating limb safe.
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