CHRONIC COMPLICATIONS
OF FRACTURE
DR. T. PRAVEEN MS ORTHO
DEPARTMENT OF ORTHOPAEDICS
KARUR MEDICAL COLLEGE
INTRODUCTION


Occurs after substantial time has passed
Defective healing process or the treatment itself
Late
complications
Related to
union
Others
Related
to union
Delayed
union
Non union
Malunion
Cross
union
Others
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






Avascular necrosis
Shortening
Joint stiffness
Sudeck’s dystrophy
Osteomyelitis
Ischemic contracture
Myositis ossificans
Osteoarthritis
Poor
healing
Normal
healing
Delayed
union
Mal union
Non union
Cross
union
Delayed union

Takes longer than the usual time
Causes:
 Inadequate blood supply
 Infection
 Incorrect splintage
 Insufficient
splintage
 Excessive traction
Signs


Tenderness +
Abnormal mobility +
Radiological :
 Fracture not united
 Ends not sclerosed
Management
conservative
Proper
splinting
Functional
bracing
Surgical
Internal
fixation &
Bone
grafting
Non union

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Healing process comes to stand before its
completion
End point of delayed union
Fracture persists for 9 months, with no signs of healing
for 3 months
Causes
Causes
Injury
Soft tissue loss
Bone loss
Intact fellow bone
Soft tissue
interposition
Bone
Poor blood supply
Poor hematoma
Infection
Pathological lesion
Presentation


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Non use of extremity
Pain at fracture site
Abnormal mobility
Joint stiffness

Radiological
 Callus
absent or static
 Medullary canal closed
 Bone ends – sclerosed
 Atrophic or oligotrophic or hypertrophic
Management

Conservative
 Functional
cast bracing
 Electrical stimulation

Operative
 Internal
fixation – hypertrophic
 Fixation with bone grafting – atrophic
Mal-union


Unites in unsatisfactory position
Causes :
Causes
Primary
Secondary
Not reduced
1.Reduced but
redisplaced
2. Infection
Presentation



Deformity
Joint stiffness
Nerve palsy
 In
humerus condyle fractures - cubitus valgus deformity
Treatment

Conservative
 Children
– observation
 Shortening alone – shoe raise

Operative
 Osteotomy
 Osteoclasis
and interal fixation
Cross union



Common in forearm fracture
Loss of supination and pronation
Cause :
 Inadequate

maintenance of introsseous space
Management :
 Proper
reduction and splinting
 Surgical excision and fat interposition
Avascular necrosis


Blood supply to a part of bone is lost because of
fracture
Leads to necrosis
Sequence
Fracture
Avascular necrosis
Secondary osteoarthritis
Joint damage and stiffness
Radiological

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Sclerosis of necrotic area
Deformed bone
Osteoarthritis
Bone scan:
 Seen
as cold area
 Earliest to diagnose
Management
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Early and Proper reduction of fractures prone for
AVN
Delay wt bearing
Excision of the necrotic fragment
Revascularisation by vascularised graft
Joint replacement