Overview of Fracture Blisters

 Overview 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. 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

Fracture blisters usually develop within days of 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 the Blister

Blisters are filled with either clear fluid or blood. The fluid inside the blister depends on the depth of skin involvement. While the treatment is similar, whether or not there is blood or clear fluid in the blister, the likelihood of scarring of the skin is higher with a blood-filled blister.

The fluid inside the blister is 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. Some topical treatments, such as Silvadene cream, has been shown to be effective in aiding the healing of ruptured 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. A blister is a good indication that definitive surgical fixation of a fracture should probably be delayed if possible until the time when the soft tissue has settled down, allowing for a safer surgical procedure without as much of a risk of complication to the soft tissue.
Treatment of 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:

The broken bone should be immobilized: This can be accomplished with a splint or an external fixator. The advantage of the external fixator is the immobilization is often better, and your doctor can see the skin. In complicated cases, this method is often preferred.
The extremity should be elevated: 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. Propping the ankle up while sitting is not elevating!
Surgery should be delayed: 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.

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 they develop, patience is necessary to allow the blister to resolve before proceeding with surgical treatment.

Just because a fracture blister has developed, does not mean that your treatment was inappropriate. Sometimes, with significant traumatic injuries, fracture blisters are inevitable. In addition, they never show up until a few days after the initial injury. A fracture blister is really just a sign of the extent of soft tissue damage surrounding the area of the broken bone. It is a useful clinical sign and an indication of the severity of soft tissue damage. Having a fracture blister certainly does not mean that you were mistreated.
A Word From Verywell

Fracture blisters can be a frightening experience for people who aren't expecting them to occur. Often showing up days after an injury, it can make people nervous that something is going wrong. Rather, the body responds to trauma with processes, like blistering, that may unfold over weeks and months. 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 physician on how to safely care for your traumatic injury.

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