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Compound fractures are complicated injuries, but not all of them cause long-term complications aside from the actual broken bone. Your healthcare providers will check for them when you’re in the emergency department and in surgery, and also during your recovery process. Complications that may occur after a compound fracture include:

  • Skin damage: The compound fracture injures your skin when it pierces it. Your skin will heal while the bones heal. Skin under the cast doesn’t require special treatment while the cast is on, but may need some care after the cast comes off.
  • Joint damage: If your compound fracture is close to a joint, it can impact that joint’s ability to move properly. The break can damage the cartilage at the ends of your bones and joints can also become stiff when bones are immobilized. You will need to do physical therapy to get the joint moving properly and surgery is sometimes necessary to get the joint back to normal movement.
  • Nerve damage: A compound fracture can crush, bruise, tear or stretch your nerves and it’s likely that you will have some mild nerve injury. These may completely heal, but it can take months (and sometimes years). Depending on the amount of damage, there are some nerve injuries that can’t heal, but these are less common than milder injuries.
  • Healing problems: In some instances the bones don’t grow back together (nonunion). Sometimes they grow back slower than normal (delayed union) and sometimes they grow back in the wrong position (malunion). Your healthcare providers will take X-rays to check on how well you’re healing and let you know whether other treatment is necessary.
  • Uneven limbs: Kids’ bones are still growing until their teen years. There are portions of the bones, near the ends, that are called growth plates. This is where kids’ bones get longer. If a growth plate in your child’s arm or leg is damaged, that bone may not grow normally and end up shorter than the other side. Your healthcare provider will tell if you if a growth plate has been damaged.
  • Shock: You may lose a lot of blood when you experience a compound fracture, which can be very scary. The blood loss might be external or internal, meaning that you may see blood from the injury or you may just see swelling as the blood is trapped under the skin. Blood loss can drop your blood pressure suddenly and severely, sending you into shock.

More severe complications include:

  • Infection: If you have a fever or there’s a strong smell coming from your cast, you might have an infection. You should treat any possible infection after a compound fracture like an emergency and get care immediately.
  • Pulmonary embolism: A pulmonary embolism is a blood clot in a vein near the fracture area, which can travel to an artery in your lung, and block it. This happens most often after a compound fracture in the pelvis or hip. If you feel suddenly short of breath after a significant fracture you need to get treatment emergently because pulmonary embolism can be fatal.
  • Osteonecrosis: Osteonecrosis is when your bone dies because of interrupted blood flow. If this happens, your provider will find it on X-ray and tell you how it needs to be treated.
  • Compartment syndrome: Any significant swelling of muscle or other tissue around the bone can press against your blood vessels. This pressure can slow or stop the blood from flowing in and out of the area. Tissues get damaged or may die, which can lead to the need for amputation of the dead tissue. Infections can set in if you develop a compartment syndrome. This infection should be treated quickly and appropriately or they can be very dangerous and possibly even fatal. Always tell your healthcare provider if you see any unusual swelling or notice an unexpected loss of sensation — or anything that concerns you after treatment for a compound fracture.
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