11-28: Fracture Blisters

Meghan Breed; Robert Warne Fitch

Clinical Summary

Fracture blisters are vesicles or bullae secondary to swelling from soft-tissue injury. The most affected areas include the tibia, ankle, and elbow. Patients note formation within 1 to 2 days after trauma and complain of pain, swelling, ecchymosis, and decreased range of motion. Complications include infection, deep venous thrombosis, and compartment syndrome.

Management and Disposition

Blisters are generally left intact, and the underlying fracture is treated.

Pearls

Blisters can be seen with other conditions, including barbiturate overdose and burns. In the setting of trauma, however, they frequently indicate an underlying fracture.
Blisters are managed in a similar fashion to second-degree burns.

FIGURE 11.86

Fracture Blisters. This patient fell down four steps on the evening prior to presentation. Upon awakening the next morning, he noted ecchymosis, swelling, and blister formation. Radiographs revealed fracture of the fibula. (Photo contributor: Daniel L. Savitt, MD.)