TREATMENT OF FRACTURE BLISTERS - A PROSPECTIVE-STUDY OF 53 CASES

From June 1987 to January 1993, 53 fractures complicated by overlying blisters were identified and prospectively followed. Data concerning t he mechanism of injury, time course in the development of the fracture blisters, clinical characteristics of the blister, fracture type and management, and soft-tissue treatment and outcome were collected. Clin ically, two types of blisters were identified: clear fluid filled and blood filled. Methods used to treat the skin blister were: aspiration of the blister, deroofing of the blister with subsequent application o f Silvadene cream or coverage with a nonadherent dressing, and leaving the blister intact and covered by a loose gauze or exposed to the air . No significant difference was found in the outcome of the skin injur y treated with the various modalities. Nineteen patients underwent ear ly open reduction and internal fixation in the presence of intact frac ture blisters. In 17 cases the incision healed within 3 days, sealing off the deeper structures, and reepithelialization of the blister bed then occurred at a later date. Two of the patients who had incisions p ass through blood-filled blisters developed wound healing complication s. Although there was no significant difference in the outcome of the soft-tissue treatment techniques, our present practice is to leave all fracture blisters intact. If the blisters rupture spontaneously, they are deroofed and covered with a nonadherent dressing. Early surgery i s contemplated in patients with intact blisters and without severe swe lling.