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 the 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. Clinically, 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 of 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 injury treated with the various modalities. Nineteen patients underwent early open reduction and internal fixation in the presence of intact fracture 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 pass through blood-filled blisters developed wound healing complications. 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 is contemplated in patients with intact blisters and without severe swelling.