Managing Lymphedema in Fracture Care

Current Concepts and Treatment Principles

Christopher Thomas, DO; Jessica T. Le, DO; Emily Benson, MD

Disclosures

J Am Acad Orthop Surg. 2020;28(18):737-741. 

In This Article

Pathophysiology

The lymph fluid contains waste material picked up from tissues by interstitial fluid as it flows through the lymphatic system to lymph nodes, where unwanted material is filtered out before returning to the circulation. This fluid contains a mix of proteins, lipids, and cells.[10] Waste products in the lymph fluid are found to interfere with the cellular processes initiated when fractures occur. Orthopaedic surgeons may encounter the lymphedema-fracture relationship in multiple ways: lymphedema may occur in an extremity in the setting of traumatic fracture or a fracture may occur in an area with previously existing primary or secondary lymphedema.[3] Regardless of the mechanism by which the lymphedema-fracture interaction occurs, lymphatic disruption leads to an accumulation of interstitial fluid distal to the area in which the disruption occurred. This accumulation of fluid greatly affects the cellular processes in the region, such as the activation of the inflammatory cascade and immune cell infiltration. Adipose accumulation and fibrosis may also occur within the tissues surrounding the disruption. The extent of damage depends on the severity of the lymphatic disruption that occurs because of trauma.[9,12]

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