surgry

Pelvic fractures

Emergency treatment Stop bleeding otherwise Stabilize pelvis Surgical tamponade laparotomy (dcs) retroperitoneum Embolization

A hemodynamically unstable patient Exclude other sources Open wound Hemothorax Hemoabdomen Long-shaft bone fractures

Operative treatment options External fixation Internal fixation screws plates Combinations

Femoral fractures

Femoral fractures Proximal femoral fractures neck fracture – intracapsular, extraarticular 31-B head fracture- intracapsular, intraarticular 31-C trochanteric area- extracapsular 31-A Classification

Proximal Femoral Fractures

medial circumflex artery lateral circumflex artery Blood supply

Incidence Elderly Young Low energy Osteoporosis Female High energy

Indication for fixation Impacted and undisplaced fracture: cannulated screws—implant of choice minimal exposure parallel to allow compression

Treatment algorithm displaced under 55 55-85 over 85 no significant co-morbidity displaced under 55 55-85 over 85

Internal fixation Multiple cannulated screws Dynamic hip screw

Internal fixation—complications 30% fixation failure/loss of reduction Avascular necrosis Nonunion

Arthroplasty—options

Arthroplasty—complications Dislocation Infection Acetabular erosion Leg length inequality

Nailing of subtrochanteric fractures The solid femoral nail 1 2 3 1 2 3

Long PFN

Indirect reduction—use of external fixator

Distal Femoral Fractures

Epidemiology 6% of all femur fractures Younger/High Energy 50% (intraarticular) open 1/3 Polytrauma 1/5 Isolated Older/Osteoporotic

Position for surgery

TibiFractures

Soft-tissue injury Complications and prognosis are directly related to the degree of soft-tissue injury

Nonoperative treatment Children Undisplaced fractures “Stable” reduced fractures Contraindication for surgery: - patient - health care team

Tibial fixation options Plate Ex Fix IMN

Compression plating—poor technique