Lower Limb Fractures

Download as pptx, pdf, or txt
Download as pptx, pdf, or txt
You are on page 1of 41

Lower Limb Fractures

Mbanga, MD, Mmed


OT Surgeon
MZRH
Lower limb fractures
• Femur
• Tibia and Fibula
• Patella
• Ankle
• Calcaneal
• Metatarsals
FEMORAL FRACTURES
• Proximal end
• Shaft
• Distal end
Proximal end
Intracapsular
• Capital : Fracture of the head
• Subcapital :below the femoral head
• Transcervical :across the mid-femoral neck
• Basicervical :across the base of the femoral
neck.
• These injuries (last three)may be correctly
termed fractures of the 'neck of femur
Proximal end
Extra Capsular
• Intertrochanteric
• Pertrochateric
• Subtrochanteric
Shaft
Distal end
• Supracondylar
• Condylar
Intracapsular fracture – Subcapital
Pertrochanteric fracture
Subtrochanteric fracture
Fracture Neck Femur
• Commonest fracture of lower limb in the
elderly
• Chances of nonunion is very high due to its
peculiar blood supply
• A trivial injury might cause this fracture due to
osteoporosis.
Garden classification
• It is classified radiologically into four types
according to Garden in 1961
• Type1 incomplete impacted fracture
• Type2 complete but undisplaced fracture
• Type3 complete with moderate displacement
• Type4 severely displaced fracture
Clinical features
• The affected limb is short and externally
rotated
• Pain and swelling at fracture site
• Can’t lift the affected leg
• Severe pain on movement
• Cant stand or put weight on affected limb
(except impacted fracture)
Treatment
• Almost always surgical
• It depends upon age and type of fracture
• If age is above 60 the treatment is THA or
hemiarthroplasty, whatever the type of fracture
• If age is between 40 and 60 and it is type 3 or 4
fracture, treatment is compressional screws orTHA
• If age is between 40 and 60 and it is type 1 or 2
fracture, treatment is to reduce the fracture and fix
with cannulated screws, sliding screw or pin and
plate(DHS). Aim is to try to retain its original head
Complications
• Nonunion
• Avascular necrosis of head of Femur
• Osteoarthritis of hip
Intertrochanteric/pertrochanteric
• As name indicates the fracture is in the
trochanteric region (greater and lesser
trochanters)
• 2nd commonest fracture of lower limb in
elderly
• Greater force is needed to cause this fracture
(as compared to neck Femur)
• Clinical feature:
• The affected limb is shorter and externally
rotated
• Pain and swelling at fracture site
• Pain on movement of leg
• Cant stand or put weight on affected leg
• Treatment
• In any type treatment is almost always internal
fixation with pin and plate(DHS) preceded by
closed or open reduction of fracture under
anaesthesia.
• Complications:
• Failed fixation
• Malunion
• Nonunion
Subtrochanteric Fracture
• As name indicates the fracture is just below the
trochanters
• This fracture may occur with trivial injury
• The fracture is always considered as pathological
fracture until and unless proved otherwise
• Clinical features:
• The affected limb is shorter and externally rotated.
• Excruciating pain is noted
• Swelling is evident
• Movement of leg causes severe pain
• Treatment:
• Is almost always surgical.
• Open reduction under anaesthesia and internal fixation with
Pin and plate(DHS), DCS, Condylar plate or intramedullary
nail with or without a locking screw into the neck and head.
• Complications:
• Failure of implant
• Delayed union
• Malunion
• Nonunion
FEMORAL SHAFT FRACTURES
• Commonly occurs in young adults
• Blood loss is severe
• Clinical features
• Pain and swelling at fracture site
• Patient may be in shock
• There may be associated injury
• Treatment
• Usually surgery
• Treat shock if any
• Immobilize the limb in a splint (Thomas splint)
• Definitive treatment is ORIF
• Implant used may be
• Interlocking Nail
• Broad Dynamic Compression Plate(DCP)
• K-nail
Supracondylar and Condylar Fracture
• May occur in adults as well as in elderly
people
• In adults it needs a great force while in elderly
it can happen following a trivial injury due to
osteoporosis
• Pain and massive swelling at knee
• Danger of neurovascular injury, so always look
for distal pulses and nerves
• Treatment
• may be conservative or operative
• conservative treatment may be in the form of
traction and braces
• operative treatment in the form of ORIF and
the implant used may be Condylar plate or
Dynamic Condylar Screw(DCS)
• Complications
• Neurovascular injury
• Joint stiffness
• Delayed union
• Nonunion
Supracondylar and Condylar Fracture
• Patella is a sesamoid bone
• Fracture is usually transverse, it may be
undisplaced, displaced or communited
• Treatment
• is usually ORIF with wires in the form of
tension band wiring
• If it is communited, partial or total
patellectomy is advisable
Fracture of Tibia
• It can be classified into three regions:
• Fracture of proximal Tibia (Tibial plateau
fracture)
• Fracture of shaft tibia
• Fracture of distal tibia
Fracture Proximal Tibia
• Sometimes called bumper fracture
• It ranges from a simple to a very complicated
fracture
• It has been classified into 6 types according to
schatzker
• This fracture is notoriuos for neurovascular
injury, so it is always assessed thoroughly
(distal pulse should be palpated)
Schatzker Classification of Tibial plateau
fractures
• I – Lateral split fracture
• II – Split-depressed fracture of lateral
• plateau
• III – Pure depression fracture of lateral
• plateau
• IV – Medial plateau fracture
• V – Bicondylar fracture
• VI – Metaphyseal-diaphyseal disassociation
Schatzker Classification of Tibial plateau
fractures
Tibial Plateau Fracture
• Clinical Features:
• Pain and massive swelling noted at knee
• Popliteal artery, tibial and common peroneal
nerves should be examined
• Treatment:
• Complete anatomical reduction and early
movement at knee is mandatory
• Generally ORIF is done by means of L-plate,
screws or K-wires, but rigid fixation is required
Tibial Plateau Fracture
• Complication:
• Compartment syndrome
• Stiffness of joint
• Deformity
• OA Knee
Fracture Shaft Tibia and Fibula
• Commonest fracture in young adults
• Commonest fracture in motor bike drivers
• Compartment syndrome is common
• Open fracture is common
• Fracture Tibia is almost always associated with
Fibula
Fracture Shaft Tibia and Fibula
• Clinical features
• Pain and swelling at fracture site
• Neurovascular injury is common
• Treatment
• Conservative is recommended
• If conservative treatment fails, ORIF is done by
means of Interlocking Nail or Plate
• Use of External fixator is common in this fracture,
esp if it is an open fracture
Fracture Shaft Tibia and Fibula
• Complications
• Vascular injury
• Compartment syndrome
• Infection
• Malunion
• Delayed union
• Nonunion
• Joint stiffness
Fracture of Distal Tibia and Fibula
• Most important fracture at lower end of tibia
and fibula is called Pott’s fracture
• It is the fracture of both malleoli or fracture of
Medial Malleolus and shaft of Fibula
• Treatment
• Almost always surgical
• ORIF is indicated by means of Malleolar screw
for Medial Malleolus and plate or Rush-nail for
Fibula
Fracture of Fibula alone
• It is non-weight bearing bone
• Usually no immobilization is needed
• Treatment:
• Analgesic and rest for few days
Asanteni sana

You might also like