Author: Dr Harriet Cheng, Dermatology Registrar, Greenlane Clinical Centre, Auckland, New Zealand. Chief Editor: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, August 2015.
Fracture blister is a tense, fluid filled blister on the skin overlying an acute boney fracture.
Fracture blister complicate approximately 3% of fractures that require hospital treatment.
Fracture blister is primarily caused by shearing forces on the skin created by angulation of a boney fracture. Other factors include:
Although the blisters appears similar to a second-degree thermal burn, they are not due to heat.
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.
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.
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.
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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