7 Musculoskeletal Complications

Recognize urgent warning signs

Worsening pain, new numbness or weakness, pale or cool fingers or toes, breathing difficulty, chest pain, fever, and wound drainage are warning signs that should not be dismissed. Compartment syndrome and pulmonary embolism are emergencies. Arrange prompt clinical assessment for concerning symptoms and emergency response for sudden chest pain or difficulty breathing.

Circulation and nerve complications

With a newly casted fracture, rapidly worsening pain that is not relieved by prescribed medication, particularly severe pain when the toes are moved upward, raises concern for Acute compartment syndrome. A warm limb and a palpable pulse do not rule it out; loss of a pulse is generally a late sign. This complication requires immediate clinical evaluation.

New numbness or tingling, pallor, coolness, or impaired movement in fingers or toes distal to an injury may indicate Neurovascular compromise. Notify the responsible clinician immediately and obtain urgent assessment rather than waiting for a scheduled check. These changes may reflect compromised circulation or nerve function, and prompt assessment is needed to prevent tissue damage.

Complications after long-bone fracture

A long-bone fracture can be followed by Fat embolism syndrome. Respiratory distress, neurologic changes such as confusion, and a fine, pinpoint rash on the upper chest are characteristic warning signs. Sudden breathing difficulty or confusion should be treated as an emergency.

Clots and infection after joint replacement

After knee replacement, new calf pain and one-sided leg swelling may indicate Deep vein thrombosis (DVT). If sudden chest pain or difficulty breathing develops, a clot may have traveled to the lungs; activate emergency response for possible Pulmonary embolism rather than encouraging walking or waiting to reassess.

After hip replacement, increasing pain or redness around the incision, wound drainage, or fever can indicate infection. Infection involving an artificial joint is serious and needs timely medical evaluation.

Sudden joint inflammation

A suddenly painful, hot, swollen joint together with fever or feeling generally unwell may indicate Septic arthritis. It can occur in a natural or artificial joint. Do not assume these symptoms are a routine arthritis flare or wait several weeks for improvement; urgent medical assessment is needed.

Maintain safe skeletal traction

For a patient receiving Skeletal traction, ensure prescribed weights hang freely and do not rest on the floor or bed. Do not remove a weight temporarily for repositioning or change the amount of weight when pain increases unless directed by the responsible clinician. Monitor circulation, sensation, and movement distal to the injury, and watch skeletal pin sites for signs of infection.

Reduce the effects of immobility

Immobility can contribute to venous clots, pressure injuries, reduced lung expansion, muscle loss, joint stiffness, and constipation. For a patient on prolonged bed rest, use the prescribed mobility plan, reposition regularly, and perform permitted breathing and limb exercises. Follow care-team instructions and fracture movement and weight-bearing restrictions; do not rely on bed rest until all pain is gone. Massage of a painful or swollen calf and fluid restriction are not appropriate substitutes for the prescribed prevention plan.

Osteoporosis and low bone density increase fracture risk. For patients with an osteoporosis-related fracture, prevention of immobility-related complications must still respect the fracture's restrictions.