Fracture blister

Author: Dr Harriet Cheng, Dermatology Registrar, Greenlane Clinical Centre, Auckland, New Zealand. Chief Editor: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, August 2015.


What is fracture blister?

Fracture blister is a tense, fluid filled blister on the skin overlying an acute boney fracture.

Fracture blister

Who gets fracture blister?

Fracture blister complicate approximately 3% of fractures that require hospital treatment.

  • They are more likely to arise over fractures where the skin directly overlies bone.
  • The most common locations are the ankle, wrist, elbow, foot and distal tibia.
  • They are more likely to occur with high-energy injury, for example motor vehicle accident.
  • Other risk factors for fracture blisters are:

What causes fracture blister?

Fracture blister is primarily caused by shearing forces on the skin created by angulation of a boney fracture. Other factors include:

  • Post-traumatic swelling
  • Tissue hypoxia due to damage to surrounding veins and lymphatics.

Although the blisters appears similar to a second-degree thermal burn, they are not due to heat.

How is fracture blister diagnosed?

Fracture blister may be diagnosed on the basis of a typical clinical appearance when an underlying fracture is present.

If there is uncertainty as to the diagnosis, skin biopsy may show a subepidermal blister with little inflammatory infiltrate. Damage to dermal elastin may also be seen.

Fracture blister histology

Prevention of fracture blister

Early repair of the underlying fracture may prevent the appearance of fracture blister. In one study, if surgery was undertaken within 24 hours the risk of fracture blisters was 2% compared with 8% when surgery was done after 24 hours.[2]

What is the management of fracture blister?

Once a blister appears, management includes good wound care and surveillance for secondary bacterial infection. It is generally recommended that the blister is left intact.

What are the complications of fracture blister?

Blistered and eroded skin may become infected. For this reason, surgeons may decide to delay internal surgical fracture fixation (repair) until the skin wounds have improved. Alternatively, an external fixation method may be chosen to stabilise the fracture.

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