Fracture Blisters: Causes and Treatment

When someone breaks a bone, particularly a bone near the surface of the skin, the soft tissue damage can cause what is known as a fracture blister. It is similar to blisters you might get from friction in that they can be filled with fluid or with blood. However, the presence of fracture blisters can affect surgical treatment of the broken bone.

This article will explore why fracture blisters form, how they are treated, the implications of fracture blisters on treating the broken bone, and potential complications of fracture blisters.

Causes of Fracture Blisters

Fracture blisters are blisters that form around the area of a broken bone, usually after a severe injury where the bone is shifted badly out of position or crushed with significant force. Fracture blisters occur in about 2.9% of all fractures that require hospitalization.

These blisters are a sign of significant soft-tissue injury. They most often occur over fractures of bones that are near the skin surface. Therefore, fracture blisters are most common with:

• Ankle fractures
• Tibia fractures
• Elbow fractures
• Wrist fractures

Fracture blisters can develop from within 6 hours to up to 2 days after a fracture. Most commonly, a broken bone is temporarily splinted after an injury, and the blisters are then seen when the splint is removed a few days or a week after the injury.

The likelihood of blistering can be minimized by preventing any further trauma to the soft tissues by rigidly immobilizing the fracture, protecting the skin with a well-molded splint, and elevating the broken extremity. Fracture blisters tend to worsen when the fracture fragments are able to move, causing further soft-tissue damage.

Inside A Fracture Blister

Blisters are filled with either clear fluid or blood. The fluid inside the blister depends on the depth of skin involvement.

The fluid inside the blister is usually sterile, and therefore, the blister should be left intact and not broken. If the blister does rupture, as they sometimes do, the roof of the blister should be left alone as the skin heals underneath. Popping the blisters and removing the skin is not the proper way to heal a fracture blister. 

Treatment of Fracture Blisters

As stated, blisters should be left alone if unruptured. If you have a broken bone that requires surgery, and there are fracture blisters in that area, the following should occur:

• Immobilization: The broken bone should be immobilized as quickly as possible. This can be accomplished with a splint or an external fixator. 
• Elevation: The extremity should be elevated as much as possible. If the ankle or tibia is the bone involved, the only way to elevate above the heart is by lying down. 
• Surgery delay: Surgery should not be performed through a fracture blister. The chance of wound complications, including infection, is too high, and surgery should be altered or delayed.
• Negative pressure wound therapy: Although more research needs to be done, using negative pressure wound therapy, also sometimes known as a "wound vac," can help heal blisters more quickly so surgery can be performed.
• Topical treatments: Treatment with dressings infused with silver has been shown to speed up recovery time from fracture blisters.

Complete healing of a fracture blister may take several weeks. Ideally, with prompt, effective treatment, the chance of developing a fracture blister will be lessened, but when it develops, patience is necessary to allow the blister to resolve before proceeding with surgical treatment.

Complications of Fracture Blisters

The most important aspect of fracture blisters is their implication for surgical repair of broken bones. If a patient has developed fracture blisters, surgery should not be performed through the blistered skin. Doing surgery through a fracture blister significantly increases the chance of wound complications, including infection.

The blister is thought to represent an indication of traumatic injury to the skin. Injury to this soft tissue can compromise the healing of a surgical wound, and therefore, any blistered skin should be carefully evaluated.

If surgery needs to be performed and fracture blisters are present, the surgery may need to be modified to avoid the blistered skin. For example, if an ankle fracture has fracture blisters in the ankle region, then rather than using plates and screws, an external fixator may be used to stabilize the bone.

Summary

Fracture blisters can be a frightening experience for people who aren't expecting them to occur. Fracture blisters are an indication of severe soft-tissue injury, and while the appearance of fracture blistering may affect the timing and type of treatment, they will help guide your treating healthcare provider on how to safely care for your traumatic injury.