Muscular Complications

myositis Ossificans

My ositis Ossificans: This is a serious but rare complication. There is ossification of muscles because of injury. Pathological changes take place only in the connective tissue around the muscles but the muscle fibres remain free from this process of ossification.

Nature of Development: Direct trauma, fracture and dislocation will produce local haematoma. Osteoblast calls appear at the site trauma. (Local biochemical changes stimulate ossification of haematoma which ultimately leads to myositis ossificans).

Site of myositis ossificans: This condition is most commonly seen around the elbow joint. Other sites of development are on the thigh and over the medial side of the knee joint.

Early Signs: Firstly, a painful swelling develops on the affected area. Restricted movement of the adjoining joint takes place. X-ray shows a radio-opaque shadow which resembles an early callus. This slowly grows to a bigger size.

Treatment: Rest to the affected part by splintage is essential. Mobility and massage stimulate further increase in ossification. Many cases regain normal movement as the condition regresses. In selected cases surgical removal by excision of the ossified area can be done.

TENDON COMPLICATIONS

Tendon complications may arise following a fracture. This includes avulsion fracture and late rupture of the tendon.

Avulsion Fracture: A small portion of the bone attached at the insertion of the tendon is separated. This is commonly seen in mallet finger, avulsion of the lesser trochanter of femur and of the tuberosity of humerus. Humerus Implants are widely used by the orthopedic surgeons while performing the surgery. Siora Surgicals Pvt. Ltd. is India based Orthopedic implant manufacturer and supplier.

Late Rupture of Tendon: Rupture of the extensor pollicis longus tendon can manifest as a late result following Colles’ fracture.

JOINT STIFFNESS

Joint stiffness is one of the commonest complications of fracture. Stiffness of short duration is expected but permanent stiffness is hazardous.

Causes of Stiffness: There are four main causes of stiffness which are as follows:

  • Peri-articular adhesion.
  • Intra-articular adhesion.
  • Muscular adhesion at the site of the fracture.
  • Degenerative arthritis.
  • Peri- articular adhesion: Injury produces oedema in the soft tissue structures surrounding the joint. Adhesion formation takes place between the capsules, ligaments, tendons and muscles. This leads to restrictive joint movement.
  • Intra- articular adhesion: Injury to the joint produces haemo-arthrosis. Fibrin is deposited inside the joint and as a result fibrinous adhesion is formed. This impairs the mobility of the joint.
  • Adhesion of muscles: This is common in cases of fractures near the joint. During the process of healing the adjoining muscles become adherent to the site of bony lesion. This interferes with the joint movement. In cases of fracture of the femur, the quadriceps muscle may become adherent and interfere with the joint movement.
  • Due to arthritic changes: Degenerative changes in the joint may develop due to direct injury to the articular surface or because of angular deformity following mal-union.

VOLKMANN’S ISCHAEMIC CONTRACTURE

This serious complication develops due to inference of the arterial blood supply to the muscles. The commonest site is in the upper limb which develops after supra-condylar fracture. On rare occasions this can also develop in lower limbs. The ultimate results of interrupted blood supply are ischaemic necrosis and fibrosis of the muscles with eventual development of contracture of the affected part. Interference in the arterial blood flow can be produced by several undermentioned reasons.

  • Spasm of the artery: Traumatic spasm can affect a segment of artery of variable length. The severity of the lesion depends upon the nature of injury.
  • External Pressure and Kinking of the Artery: The artery may be kinked by the bony projections which can lead to interruption of blood flow.
  • Thrombosis of the artery: Internal injury of the artery will damage the intimal lining of the blood vessel. This can produce arterial thrombosis of variable length and ischaemia to the distal segment.

Diagnosis: There is discoloration, swelling, numbness, feeling of cold and impaired arterial pulsation of the affected part.

Treatment

  • Divide any constricting bandage or bivalve the plaster.
  • Release the acute angulation of the joint and feel for the radial pulsation.
  • X-ray is done to exclude any bony projection and this is corrected by proper reduction.
  • Keep the limb elevated and uncovered.

Surgical Intervention: This may be necessary at an early stage when conservative measures fail to improve the condition. This involves exposure of the vessel, application of papaverine solution to the artery, removal of thrombus and excision of the damaged artery and arterial graft. Diagnosis of Dislocation and Subluxation