Management of Extremity Fractures and Complications

Abstract

Trauma-associated extremity injuries are common and may lead to significant morbidity and mortality and can even be immediately life threatening. A thorough understanding of the management principles for traumatic extremity injuries is essential. Proper management of traumatic extremity fractures can mitigate development of detrimental inflammatory and infectious sequelae and preserve function. Gram-positive antibiotic prophylaxis with débridement and washout within 24 hours of injury is supported for all open fractures, with broader antibiotic coverage against gram-negative bacteria supported for Gustilo-Anderson type III open fractures. Extremity vascular injury in civilian trauma is rare but must be promptly identified to prevent irreversible limb ischemia. Rhabdomyolysis and compartment syndrome are feared complications of severe extremity trauma. Aggressive volume resuscitation for rhabdomyolysis is widely accepted to support renal function. When compartment syndrome is suspected, maintaining extremity perfusion is critical, and fasciotomy may be necessary for compartmental decompression. The mangled extremity can threaten limb viability, function, rehabilitation potential, and, in some cases, life. It is best treated in a multidisciplinary setting with the decision to salvage or amputate based on careful expert consensus evaluation. This review contains 4 figures, 5 tables, and 88 figures. Key words: compartment syndrome, extremity injury, extremity vascular injury, open fracture, mangled extremity, rhabdomyolysis, tourniquet use, trauma