Which action is avoided when managing fracture blisters?

• A. Aspiration
• B. Leave intact and dress
• C. De-roof the blister
• D. Incision and drainage

Answer: (C)

Fracture blisters indicate significant soft-tissue injury, and protecting the fragile skin around the fracture is the priority. De-roofing the blister removes the protective roof, exposing raw, compromised skin that heals poorly in the setting of a fracture and fixation. This greatly increases the risk of infection, skin necrosis, and wound complications once surgery proceeds. Because of that, this action is avoided. The preferred approach is to keep the blister intact and cover it with a nonadherent dressing, immobilize to reduce further trauma, and delay definitive fixation until soft tissues have settled. If needed to relieve pressure, aspiration of the blister contents can be considered to reduce tension while preserving the roof. Incision and drainage would also breach the protective skin envelope and is not favored.