Fracture blisters are a rare occurrence after you fracture or break a bone. They can also occur after you have surgery on a bone. Fracture blisters occur in about 2.9 percent of all fractures.
The ankle is the most common location where fracture blisters occur since the bone is closer your skin’s surface and isn’t surrounded by much fat or muscle. It’s possible to have multiple fracture blisters at one time.
A fracture blister will usually appear about two and a half days after an injury. However, a fracture blister may show up as early as six hours or as late as three weeks after injury. These blisters can take three weeks or more to heal.
What are the symptoms of fracture blisters?
Fracture blisters occur on or around the area of a fracture injury. They form underneath the outermost layer of your skin and are filled with fluid. The fluid usually has a serum or gel-like texture.
The blisters themselves are usually painless although the injury itself may be painful. Doctors usually divide fracture blisters into two types: hemorrhagic and serous.
Serous fracture blisters have the following characteristics:
- clear fluid
- tense or tight skin on top of the blister
- partial separation of epidermis and dermis
Symptoms of hemorrhagic blisters include:
- blood or red-colored fluid
- loose skin on top of the blister
- complete separation of epidermis and dermis
Hemorrhagic fracture blisters usually occur with more severe fracture injuries. Sometimes you can have both serous and hemorrhagic fracture blisters at once.
What are the causes?
When you break a bone, your body naturally releases inflammatory compounds that cause edema or swelling. The swelling puts extra strain on blood vessels. As a result, the normal bond between the epidermis (outermost layer of skin) and the dermis (layer underneath the epidermis) separates. This allows fluid to enter between the two areas, creating a blister.
Fracture blisters can sometimes occur after a person has elective foot or ankle surgery. These surgeries aren’t performed in response to an injury and can include hammer toe correction or bunion removal. However, fracture blisters in these cases are rare.
Because of the natural swelling that occurs following surgery or a fracture, it’s extremely important to elevate your leg or foot to minimize swelling and help prevent fracture blisters.
What are the treatment options?
You shouldn’t try to treat or pop a fracture blister yourself. If you notice a fracture blister, see your doctor so they can evaluate and determine the best method of treatment.
If surgery isn’t planned, your doctor will typically let the blister heal on its own. Some doctors may even opt to allow blisters time to heal before performing surgery on a fracture. The approach depends on the number and blister type as well as the injury itself.
Serous fracture blister
In treating a serous fracture blister, your doctor may use a small blade to puncture the blister’s base and drain the fluid. Because the blister covers your skin, the blister site is a protective layer. Your doctor may then apply a special dressing and antibiotic ointment to prevent infection.
Hemorrhagic fracture blister
Since the top of a hemorrhagic fracture blister isn’t tight, it’s not as easy to drain. Your doctor will usually remove the top portion of a hemorrhagic blister to drain the fluid. They’ll then apply special ointment and gauze to promote healing.
Your blister should then start to heal and new skin will form. New skin typically forms in about one to two weeks. As a general rule, hemorrhagic blisters take longer to heal.
To help reduce your risk of complications, keep the bandaged area clean and dry and follow your doctor’s instructions.
What are the possible complications?
The most concerning side effects for fracture blisters are infection and wound rupture if the blister occurs after surgery. The blisters could stop your wound from healing properly. If your blister is in very close proximity to a surgical incision, your doctor may choose not to drain it.
Fracture blisters can also create scarring on your skin, especially when the blisters are filled with blood.
A fracture blister is sterile until the blistered area is broken. At that time, bacteria can invade the skin and lead to infection. The symptoms associated with skin infections include:
- drainage of pus
What is the outlook?
Fracture blisters will usually heal with time, though it may take several weeks. If you don’t need surgery for your fracture, your blister should be left to heal on its own. If you do need surgery, you may need to allow time for your blister to heal before further treatment of your fracture.