FRACTURE BLISTERS

By Gary M. White, MD


Fracture blisters (FB) are blisters that occur soon after and in the skin overlying a fracture of a bone, usually of the calcaneous or ankle. Less frequently, they may occur after fracture of the elbow.

Clinical

The blister forms with 24-48 hours of a high-impact closed fracture. The blisters are subepidermal and the surrounding skin is edematous. Two types of blisters have been described. The first is filled with clear fluid and results from separation within the epidermis. The second is hemorrhagic and results from separation at the dermal-epidermal junction.

Treatment

Appropriate treatment of the fracture is of course paramount. With regard to the blisters, ice and elevation are recommended early. Some recommend removing the blister and applying appropriate wound care to the subsequent ulcer. Others recommend leaving the blister roof intact to serve as a biologic dressing.

References

West J Emerg Med. 2011 Feb; 12(1): 131–133.

A 33 year old man fell 7 m, landing on his left foot. He sustained an intra-articular displaced fracture of his left calcaneus with moderate swelling and no other injuries. Owing to delays in the radiology department, the patient discharged himself and continued weight bearing on the left limb. He was readmitted later that evening with a severely swollen left foot and leg and severe fracture blisters. BMJ. 2005 May 7; 330(7499): 1094.

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