Fracture blister

What is a fracture blister?

A fracture blister is a tense, fluid filled blister on the skin overlying an acute bony fracture.

Fracture blister 

Fracture of humerus 

Who gets fracture blisters?

Fracture blisters 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:
  • Peripheral vascular disease
  • Connective tissue disease
  • High blood pressure
  • Smoking
  • Diabetes mellitus
  • Lymphatic obstruction.

What causes fracture blisters?

Fracture blisters are primarily caused by shearing forces on the skin created by angulation of a bony fracture. Other factors include:

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

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

How is a fracture blister diagnosed?

Fracture blisters 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 blisters

Early repair of the underlying fracture may prevent the appearance of fracture blisters. 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 blisters?

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 blisters?

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.