Complications of Fractures

•Non-union
•DVT
•Damage to Nerves and Blood Vessels
•Compartment Syndrome
•Fat Emboli
•Infection (Osteomyelitis)
 Clinical Decisions
Bobbie, age 14, was admitted with fx
left tibia about 10 hrs age. He has a
long leg cast.
Report states: “toes warm, pink with
good capillary refil, pulses
present...pain not controlled with
MS.”
You note: p. 88,BP 89/66, r.23, t 98.6.
Bobbie reports: ‘toes feel “funny”,
left leg hurts at calf.”
Questions
 What additional data should you
gather?
 What is the medical/nursing problem
of greatest Priority?
 Why did this occur?
 What actions should you take?
Compartment Syndrome
 Compression of structures within a
defined boundry; capillary perfusion
decreased.
 Self-perpetuating edema-ischemia
cycle...inc. capillary
permeability...arterial
obstruction...muscle and tissue
death.
Etiology  Factors affecting
– dec. BP
 Normal – dec. oncotic
pressure
compartment
– inc. capillary
pressure=10mm permeability
Hg – obs. venous flow
 Above 30mmHg – length of time
for 8 hrs =  Causes
Permanent
damage
Arterial circulation continues; capillary
circulation stops!
Events Leading to Compartment
Syndrome
 Ischemia cycle  More fluid leaves
capillaries than enters;
 Edema with inc. inc. permeability of
capillary pressure capillary walls due to
 Capillaries histamine release due
dilate;hydrostatic to ischemic muscles
filtration pressure  Plasma proteins into
becomes greater than interstitial fluids
oncotic pressure of  Inc. intramuscular
plasma colloid pressure-obstructs
venous first, then
arterial
 Compartment
syndrome has many
causes.

Describe the
etiology in these
examples.

compartment
Compartment Syndrome
 Types  Lead to Volksmans
– Acute ischemic
contraction
– Chronic
 Microcirculation  May develop Crush
ceases when Syndrome:Rhabdo
compartment myolosis=Myoglob
pressure = inuric renal failure
diastolic BP
Volksman’s
ischemic
contracture
may result with
compartment
syndrome!
 Compartments Affected
 Forearm
– deep volar
– superficial volar
 Lower leg
– deep posterior
tibial
– anterior with
peroneal nerve
– lateral with Lower
superficial peroneal leg
– posterior with sural
•Assessment
•Pain on passive stretch
•Progressive pain
•Tenseness of muscle
compartment
•Motor weakness
•Dec. sensation
•Loss of pulse
Interventions

 Ice and elevate

 Early recognition
– 5 Ps
– Pressure monitors
 Dec. pressure
– Remove what
confines
– Eval. response to
meds
Medical/Surgical Interventions
 If compartment syndrome present,
elevate limb only to heart level, not
above!
 Prevent complications associated with
myogolbinuria
 Monitor for compartment syndrome
 Prevent infection
 Fasciotomy
 Fasciotomy!
Monitor for Treatment
compartment Treatment for
syndrome compartment
syndrome.
Prevent
 Fat emboli
Fat Emboli
 Fat globules obstruct blood vessels
 Causes
– Metabolic: biochemical changes, lipids
mobilized and embolize, fatty acids
toxic
– Mechanical: fat is liberated due to inc.
pressure
 Life-threatening: ARDS
Fat Emboli
 Frequency
 Recognition
– Change in
behavior
– Respiratory chg
– Cardiac chg.
– Integumentary
system (Late)
– Urine fat, dec.
platelets  Non-blanching petechiae at
these sites; late finding!
 Diagnostic Tests

Blood gases
Lung scan
Chest x-rays
Laboratory
studies:
platelets, urine
fat

Nursing
diagnosis

Lung changes with fat

emboli (ARDS)
Interventions: Fat emboli
 Prevent: recognize,
immobilize, hydrate
 O2 therapy
 Steroids
 Fluid volume
replacement
 Plasma expanders
 Monitoring