FRACTURE BLISTERS - CLINICAL AND PATHOLOGICAL ASPECTS

Fracture blisters are tense vesicles or bullae that arise on markedly swollen skin directly overlying a fracture. There is very little objec tive data in the literature detailing their characteristics and manage ment. All fracture blisters that occurred over a 3 1/2-year period wer e studied retrospectively at four hospitals, of which three were level I trauma centers. A total of 53 blisters developed in 51 patients. Th ey occurred in characteristic locations along the human musculoskeleto n, most commonly overlying the tibia, ankle, and elbow. They arose wit hin 24-48 h of acute injury in most instances. The timing of surgical intervention affected the occurrence of fracture blisters. Those patie nts with acute fractures who underwent open reduction internal fixatio n (ORIF) within 24 h of injury had the lowest incidence of fracture bl isters (2.0%) compared with those delayed for >24 h (8.0%) (p < 0.001) . In those patients with fracture blisters present at time of surgery, patient care was affected in 10 of 13 cases (71%). Two of these were major complications occurring as postoperative wound infections. Other management problems consisted of delaying surgery, and changing in th e operative plan, There were no adverse affects on patient care when t he fracture blister developed postoperatively. Twenty-one fractures wi th blisters were treated by closed means, with the presence of fractur e blisters delaying closed reduction and casting in two. Biopsy examin ation of 15 blisters supported the clinical impression that fracture b listers are subepidermal vesicles. The blister fluid was found to be a sterile transudate. Microbial evaluation of 11 ruptured fracture blis ters demonstrated colonization (primarily with skin pathogens), occurr ed soon after blister rupture, and continued until reepithelialization .