Arm and leg fractures
Arm and leg fractures usually result from trauma and commonly cause substantial muscle, nerve, and other soft-tissue damage. The prognosis varies with the extent of disablement or deformity, the amount of tissue and vascular damage, the adequacy of reduction and immobilization, and the patient’s age, health, and nutritional status.
Children’s bones usually heal rapidly and without deformity. Bones of adults in poor health and with impaired circulation may never heal properly. Severe open fractures, especially of the femoral shaft, may cause substantial blood loss and life-threatening hypovolemic shock.
Causes
Most arm and leg fractures result from major trauma—for example, a fall on an outstretched arm, a skiing accident, or child abuse (shown by multiple or repeated episodes of fractures). However, in a person with a pathologic bone-weakening condition, such as osteoporosis, bone tumors, or metabolic disease, a mere cough or sneeze can also produce a fracture. Prolonged standing, walking, or running can cause stress fractures of the foot and ankle—usually in nurses, postal workers, soldiers, and joggers.
Signs and symptoms
Arm and leg fractures may produce any or all of the five Ps: pain and point tenderness, pallor, pulse loss, paresthesia, and paralysis. (The last three are distal to the fracture site.) Other signs include deformity, swelling, discoloration, crepitus, and loss of limb function. Numbness and tingling, mottled cyanosis, cool skin at the end
of the extremity, and loss of pulses distal to the injury may indicate arterial compromise or nerve damage. Open fractures also produce an obvious skin wound.
of the extremity, and loss of pulses distal to the injury may indicate arterial compromise or nerve damage. Open fractures also produce an obvious skin wound.
Complications of arm and leg fractures include:
hypovolemic shock as a result of blood vessel damage (This is especially likely to develop in patients with a fractured femur.)
permanent deformity and dysfunction if bones fail to heal (nonunion) or heal improperly (malunion)
aseptic necrosis of bone segments from impaired circulation
muscle contractures
renal calculi from decalcification (produced by prolonged immobility)
fat embolism.
Diagnosis
A history of trauma and a physical examination, including gentle palpation and a cautious attempt by the patient to move parts distal to the injury, suggest an arm or a leg fracture.
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