Introduction to Trauma X-ray Fracture complications
Fractures are often complicated by soft tissue injury which may need to be treated prior to obtaining X-rays
Soft tissue injuries are usually better appreciated on clinical examination than on X-rays
Complications may also relate to treatment of fractures
Soft tissue injury complications
Many bone fractures are complicated by a significant soft tissue injury that the X-ray may or may not show. Soft tissue injuries may be threatening to life or limb, and for this reason thorough clinical examination is required BEFORE obtaining the X-ray. For example, it is essential to check for neurological and vascular compromise, which may mean immediate fracture reduction is appropriate prior to imaging.
An 'open fracture' is any fracture complicated by breach in the adjacent skin. This is evident clinically and often difficult to appreciate on X-rays.
A 'closed fracture' (no break in skin) that is clinically complicated by soft tissue injury is correctly termed a 'complex fracture'.
The soft tissue injuries associated with complex and open fractures are usually more evident clinically than on X-ray.
Blood supply of the scaphoid is from distal to proximal
Injury to the blood supply may result in AVN
Bone sclerosis of the proximal pole can be a sign of AVN
Osteopenia and Sudeck's atrophy
Normal bone formation is influenced by mechanical stress. Occasionally fractures requiring prolonged immobilisation will result in osteopenia due to disuse.
Reduced bone density may also result from Sudeck's atrophy, also known as 'reflex sympathetic dystrophy' or 'complex regional pain syndrome'. This is a painful syndrome which is poorly understood, but thought to be caused by dysfunction of the autonomic nervous system and regulation of blood supply.