General complications of fractures

General complications of fractures
presented by:
                             R.R.M.F.A
General complications


Deep vein thrombosis and pulmonary embolism

** Deep vein thrombosis and pulmonary embolism.

**Tetanus.

**Gas gangrene.

** Fat embolism syndrome.

** hypovolemic Shock.

crush syndrom

** DVT is very common complication after fracture and major orthopedic operation.

** Site: leg, thigh and pelvic vein.

**Risk factors:

       à Knee and hip replacement 

       à Elderly

       à Immobility

       à Malignancy and CV disease

       à Trauma ( fracture of spine , pelvis , femur and         tibia)

       à hypercoagulable status

 Symptoms  and signs

 

1. Pain and tenderness in calf or thigh usually unilateral

2. swelling

3.hotness

4. positive homan’s sign.

5. pulmonary embolism as primary presentation ( dyspnea, hemoptysis ,

Diagnosis:
Duplex ultrasonography , V-Q scan,
    spiral CT and angiography.

Prevention:
1.Elastic stockings.

2.Elevation the foot.

3.Early mobilization.

4.Low molecular weigh heparin 40mg\day 


Tetanus

* Is wound infection caused by C.tetani .

** Tetanus toxin passes to anterior horn cells

where it fixed and can’t be neutralized so

produces hyper excitability and reflex muscle spasm.

Symptoms:

**Tonic and clonic contractions of esp. jaw, face, around the wound itself ,neck ,trunk, finally spasm of the diaphragm and intercostal  muscles leads to asphyxia and death.

Treatment:
1. IV antitoxin.
2. IV antibiotics (penicillin).
3. Muscle relaxant.
4. Tracheal intubation.
5. Control respiration

Gas gangrene

Cause:

It caused by clostridium (perfringens) and this organism survive and multiply only in tissue with low oxygen tension. Characterized by rapid and extensive necrosis  of muscle accompanied by gas formation and systemic toxicity .

Its associated with traumatic wounds that are deep, necrotic and without communication to the surface
Clinical features:

1. sudden onset of pain localized to the infected area.

2. swelling , edema

3.no pyrexia (cool)

4.profuse serous discharge with sweetish and mousy odor .Gas production