injuries and poisoning
Overview of Fractures
Complications of Fractures
Fractures can be accompanied by or lead to other problems (complications). However, serious complications are unusual. The risk of serious complications is increased if the skin is torn or if blood vessels or nerves are damaged. Some complications (such as blood vessel and nerve damage, compartment syndrome, fat embolism, and infections) occur during the first hours or days after the injury. Others (such as problems with joints and healing) develop over time. Many fractures cause noticeable bleeding around the injury. Rarely, bleeding within the body (internal bleeding) or from an open wound (external bleeding) is massive enough to cause a life-threatening drop in blood pressure ( Shock ). For example, shock may result when fractures of the thighbone (femur) or pelvis cause severe internal bleeding. If a person is taking a drug to prevent blood clots from forming (an anticoagulant), relatively minor injuries can cause substantial bleeding. A dislocated hip or knee can disrupt blood flow to the leg. Thus, the tissues in the leg may not get enough blood (called ischemia) and may die (called necrosis). If enough tissue dies, part of the leg may have to be amputated. Sometimes fractures of the elbow or upper arm can disrupt blood flow to the forearm, causing similar problems. A disrupted blood supply may not cause any symptoms until several hours after the injury. Sometimes nerves are stretched, bruised, or crushed when a bone is fractured. A direct blow can bruise or crush a nerve. These injuries usually heal on their own over weeks to months to years, depending on the severity of the injury. Some nerve injuries never heal completely. Rarely, nerves are torn, sometimes by sharp bone fragments. Nerves are more likely to be torn when the skin is torn. Torn nerves do not heal on their own and may have to be repaired surgically. is the most common severe complication of serious fractures of the hip or pelvis. It occurs when a blood clot forms in a vein, breaks off (becoming an embolus), travels to a lung, and blocks an artery there. As a result, the body may not get enough oxygen. Having a hip fracture greatly increases the risk of pulmonary embolism because it involves Injury to the leg, where most of the clots that cause pulmonary embolism form Forced immobility (having to stay in bed) for hours or days, slowing blood flow and thus giving clots the opportunity to form Swelling around the fracture, which also slows blood flow in the veins About one third of people who die after a hip fracture die of pulmonary embolism. Pulmonary embolism is much less common when the lower leg is broken and is very rare when the arm is broken. Fat embolism rarely occurs. It can occur when long bones (such as the thighbone) are fractured and release fat from the bone's interior (marrow). The fat may travel through the veins, lodge in the lungs, and block a blood vessel there, causing . As a result, the body does not get enough oxygen, and people may become short of breath and have chest pain. Their breathing may become rapid and shallow, and their skin may become mottled or blue. Rarely, Compartment Syndrome develops. For example, it may develop when injured muscles swell a lot after an arm or a leg is broken. Because the swelling puts pressure on nearby blood vessels, blood flow to the injured limb is reduced or blocked. As a result, tissues in the limb may be damaged or die, and the limb may have to be amputated. Without prompt treatment, the syndrome can be fatal. Compartment syndrome is more likely to occur in people who have certain If the skin is torn when a bone is broken, the wound may become infected, and the infection may spread to the bone (called Osteomyelitis , which is very difficult to cure). Fractures that extend into a joint usually damage the cartilage at the ends of bones in the joint (called joint surfaces). Normally, this smooth, tough, protective tissue enables joints to move smoothly. Damaged cartilage tends to scar, causing Osteoarthritis (OA) , which makes joints stiff and limits their range of motion. The knee, elbow, and shoulder are particularly likely to become stiff after an injury, especially in older people. Physical therapy is usually needed to prevent stiffness and help the joint move as normally as possible. Surgery is often needed to repair the damaged cartilage. After such surgery, the cartilage is less likely to scar, and if scarring occurs, it tends to be less severe. Some fractures can make a joint unstable, increasing the risk of repeated injuries and osteoarthritis. Appropriate treatment, often including a cast or splint, can help prevent permanent problems. In children, if a Growth Plate Fractures in a leg is fractured, the affected leg may not grow normally and may be shorter than the other leg. Growth plates, which are made of cartilage, enable bones to lengthen until children reach their full height. If a fracture does not involve the growth plate, it may stimulate bone growth from the fracture site itself. If it stimulates growth, the fractured leg may grow too much and be longer than the other leg. In adults, surgery to repair the thighbone may result in one leg that is longer than the other. Sometimes broken bones do not grow back together as expected. They may Not grow back together (called nonunion) Grow back together very slowly (called delayed union) Grow back in the wrong position (called malunion) These problems are more likely to occur when The broken bones are not kept next to each other and are not kept from moving (meaning they are not immobilized with a cast or a splint). The blood supply is disrupted. Certain disorders, such as Diabetes Mellitus (DM) and When blood flow to a bone is disrupted, part of the bone may die, resulting in Osteonecrosis . Certain injuries (such as scaphoid wrist fractures and hip fractures in which the broken bones are out of place) are more likely to cause osteonecrosis. 