Fracture blister
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| Fracture blister | |
|---|---|
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| Example of fracture blister | |
| Specialty | Dermatology |
Fracture blisters occur on skin overlying a fractured bone, and fractures complicated by the development of overlying blisters remain a clinical dilemma in orthopedics.[1][2]: 43
Fracture blisters are tense
At the location of the fracture, there is an increase in compartment pressure that is found around the area in limbs where blisters do not form and a fasciotomy is not performed, versus in those where the blisters are found. It is presumed that the formation of the blisters relieves some of the myofascial pressure.. [4] It can be noted that there is a decreased number of tight junctions and activation of the paracellular pathway in the blistered skin, allowing for fluid passage into the blister.[4]
These blisters are thought to be caused by
Risk factors that predispose a patient to formation of a blister include but are not limited to: anatomical sites with thin and tightly adhered overlying skin, peripheral vascular disease, collagen vascular disease, hypertension, smoking, alcoholism, diabetes mellitus, lymphatic obstruction, high energy injuries, and grade I and II open tibia fractures. [3]
Repair of the fracture prior to the formation of a blister is most ideal option. However, if that cannot be done, decision to pop the blisters in order to treat the fracture or wait for them to heal first usually hinges on the preferences of the orthopaedic surgeon as there is a lack of data on what treatment is ideal.[3] Waiting delays care an average of 7 days, and longer for tibial plateau and calcaneal fractures. Operating immediately anecdotally increases wound infection rates.
Additional images
References
- S2CID 13275491.
- ISBN 978-0-7216-2921-6.
- ^ PMID 21691490.
- ^ PMID 36032734.
- ^ PMID 7602633.
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