complication of leg fracture

Possible complications of leg fracture:
-delayed union or non-union.
-malunion of bone that may predispose to arthritis.
-leg shortening.
-osteomyelitis.
-injury to deep peroneal nerve may lead to footdrop.
-popliteal artery injury in upper tibial fracture.
-reflex sympathetic dystrophy.
-compartment syndrome.
-Tetanus (possibly???) since a rusty spring pierces into James' leg.

Tetanus

Causative agent :Tetanus Toxin produced by Clostridium Tetani. (gram +ve, rod-shaped, produce endospores, usually found in soils, anaerobic type of metabolism.)

How does the tetanus toxin cause damage to the body?

The tetanus toxin affects the site of interaction between the nerve and the muscle that it stimulates. This region is called the neuromuscular junction. The tetanus toxin amplifies the chemical signal from the nerve to the muscle, which causes the muscles to tighten up in a continuous ("tetanic" or "tonic") contraction or spasm. This results in either localized or generalized muscle spasms. The jaw is "locked" by muscle spasms, giving the name "lockjaw" (also called "trismus"). Muscles throughout the body are affected, including the vital muscles necessary for normal breathing. When the breathing muscles lose their power, breathing becomes difficult or impossible and death can occur without life-support measures. Even with breathing support, infections of the airways within the lungs can lead to death. Tetanus toxin can affect neonates to cause muscle spasms, inability to nurse, and seizures. This typically occurs within the first two weeks after birth and can be associated with poor sanitation methods in caring for the umbilical cord stump of the neonate.

How is tetanus treated and prevented?

Antibiotics and drainage are carried out in the hospital while the patient is monitored for any signs of compromised breathing muscles. Treatment is directed toward stopping toxin production, neutralizing its effects, and controlling muscle spasms. Sedation is often given for muscle spasm, which can lead to life-threatening breathing difficulty.

In more severe cases, breathing assistance with an artificial respirator machines may be needed.

The toxin already circulating in the body is neutralized with antitoxin drugs. The tetanus toxin causes no permanent damage to the nervous system after the patient recovers.

Active immunization ("tetanus shots") to prevent tetanus. (5 yrs once) Preventative measures to protect the skin from being penetrated by the tetanus bacteria are also important. For instance, precautions should be taken to avoid stepping on nails by wearing shoes. If a penetrating wound should occur, it should be thoroughly cleansed with soap and water and medical attention should be sought. Finally, passive immunization can be administered in selected cases (with specialized immunoglobulin).