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Fracture blisters

C P Giordano1, K J Koval, J D Zuckerman

  • 1Department of Orthopaedics, Hospital for Joint Diseases, New York, NY 10003.

Clinical Orthopaedics and Related Research
|October 1, 1994
PubMed
Summary
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Fracture blisters in ankle fractures are classified as clear or blood-filled. Blood-filled blisters indicate a deeper injury and may increase the risk of delayed surgical wound healing.

Area of Science:

  • Orthopedic Surgery
  • Dermatopathology
  • Wound Healing Research

Background:

  • Fracture blisters are observed in patients with severe injuries, particularly fractures.
  • Their clinical and histological characteristics and impact on surgical outcomes are not fully understood.

Purpose of the Study:

  • To clinically and histologically characterize fracture blisters associated with surgically treated ankle fractures.
  • To evaluate the impact of blister presence and type on surgical timing and wound healing.

Main Methods:

  • A cohort of 13 patients with surgically treated ankle fractures and associated blisters was studied.
  • Clinical assessment and histological examination of skin biopsies from blister edges and beds were performed.
  • Surgical timing was based on soft tissue swelling, irrespective of blister status.

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Main Results:

  • Two clinical blister types were identified: clear fluid-filled and blood-filled.
  • Histological analysis revealed a cleavage injury at the dermoepidermal junction in both types.
  • Blood-filled blisters showed a complete absence of dermal epidermis, suggesting a deeper injury.
  • Most incisions healed well, but one patient with an incision through a blood-filled blister experienced delayed healing.

Conclusions:

  • Fracture blisters, regardless of type, did not influence surgical timing in this cohort.
  • Blood-filled blisters represent a more severe injury than clear fluid-filled blisters.
  • Incisions through blood-filled blisters carry a higher risk of delayed wound healing.