FRACTURES 0F LOWER LIMB BY Vishnu Mohan

Topics Mechanism of fractures fracture of femur fracture of patella Tibial and fibular Fractures. Ankle fractures fracture of foot Fracture of pelvis.

fractures A bone fracture is a medical condition in which there is a break in the continuity of the bone

Types Closed{simple} open{compound} Compression Complete Incomplete Linear Transverse Oblique Spiral Impacted comminuted

Mechanism of fractures Lower limb fracture is a result of a high energy trauma except in elderly people or diseased bones Types of fracture are depend on position of limb during impaction and magnitude of forces applied.

femur Upper end shaft Lower end

Fractures of head of femur The head and neck of the femur is primarily intended for transmission of body weight efficiently with minimum bone mass.

- Mechanism : - Minimal trauma in old people with osteoporosis - High energy trauma in young adults .

Intracapsular Extracapsular Types Intracapsular Extracapsular

Intracapsular types subcapital- just distal to femoral head Transcervical– at the middle of femoral neck

Extracapsular types Intertrochanteric- passes between two trochanters pertrochanteric –passes through the two trochanters,one or both of which may be seperated Subtrochanteric -2or3 inches below lesser trochanter

incomplete fracture of the neck (so called abducted or impacted)

complete without displacement

this is a complete femoral neck fracture with full displacement: the proximal fragment is free and lies correctly in the acetabulum so that the trabeculae appear normally aligned

- Immobilization with traction until surgery - Management : - Immobilization with traction until surgery - Surgery: indicated to stabilize the fracture to help healing, - Internal fixation by, angled plate , condylar plate or multiple pins . - Arthroplasty

Surgical reconstruction or replacement of degenerated joint Arthroplasty Surgical reconstruction or replacement of degenerated joint

Examples of Internal Fixation

Fracture of Femoral Shaft : - Mechanism : - High energy trauma , falling from height - Management : - Closed reduction ( In children ) - Open reduction internal fixation by plate and screws or interlocking nail .( In adult) - External fixator .

Open reduction of a fracture involves making an incision in the skin and putting the fractured bones together and stabilizing with screws or plates or rods. Closed reduction means just that: no incision made, the fracture is manipulated under a type of X-ray machine called fluoroscopy or just by feel and a cast is then usually applied. Open usually leads to quicker healing because the fragments are held together. Closed has the advantage of avoiding an operation but the healing can be slower because the bones are not rigidly held together.

External fixator

splint   a rigid or flexible appliance for fixation of displaced or movable parts Thomas splint A long leg splint that extends from a ring at the hip to beyond the foot, allowing traction to a fractured leg, and is used in emergencies and for transportation.

(B), Thomas knee splint.

PATELLAR FRACTURES

circular-triangular bone The patella, also known as the knee cap or kneepan  circular-triangular bone  It is the largest sesamoid bone in the human body.

PATELLAR FRACTURES Caused by direct injury or by indirect injury The type of fracture is different in both Treatment is also different

1.direct [stellate] 2.indirect [transverse] Types 1.direct [stellate] 2.indirect [transverse]

Direct Mechanism- a fall on patella, heavy object falling across the knee Inspection- knee joint is extremely swollen, in slightly flexed position Palpation- effusion in the knee joint is easily determined

X ray- shows fracture lines running radialy X ray- shows fracture lines running radialy. There may or may not be any displacement full extension of the knee joint is possible in majority of cases.

Treatment 1.When there is crack fracture with no displacement operation is not needed 2. Even slight displacement patellectomy is the treatment of choice, irregular articular surface of patella will damage the femoral articular cartilage and lead to osteoarthritis early in age

pattellectomy An operation to remove the patella.

Indirect Mechanism- when a person slips on leg with the other leg in a semi flexed position Inspection- there is swelling but is less than direct fracture Palpation- one can feel the fracture line and even gap between the segments the patient is unable extend the knee and is also unable to lift the leg

Treatment 1.Undisplaced crack fracture by plaster cylinder 2.With separation{in middle} a) internal fixation b) patellectomy

Fracture Tibia & Fibula : - Mechanism : - Direct trauma , falling . - Management : - Closed reduction & cast immobilization . - Open reduction internal fixation by plate and screws or inter locking nail .

Tibial and fibular fractures

Fractures of the Ankle

Fractures of the Ankle Classification : Management : - According to mechanism of injury : - Abduction - Adduction - Ext. rotation - Vertical compression Management : Surgical treatment is indicated to restore normal anatomy and function of ankle joint

Examples of Internal Fixation

Fractures of foot

Fractures of calcaneum Mechanism - fall from height degree of displacement also varies according to the violence Types Chip fractures- rare type Split fractures- split in to two fragments Crush fractures- the portion which articulates with talus is completely crushed

Functional treatment a crepe bandage is applied, the foot is elevated and active exercises are encouraged from the beginning. Majority of patients return to full activity within 6 months.

Fractures of metatarsal bones

Mechanism – from direct violence usually at the neck Treatment - mainly functional method Stress fracture{march fracture} – due to long march or overuse mostly in 2nd metatarsal

Pelvis Fractures

Pelvis – three bones make up each side of the pelvis Pelvis – three bones make up each side of the pelvis. (ilium, ishium,and pubis). They are connected to the sacrum by ligaments.

Causes… Elderly people with osteoporosis. May fracture pelvis during a fall. These injuries do not usually damage the structural integrity of the pelvic ring, but may fracture an individual bone.

Causes… High- energy forces – what most fractures involve Crush accident Falls Surgical treatment may need to be done, depending on the direction and degree of the forces Injuries can possibly be life-threatening

Blood vessels and nerves Diagnosis… X-Rays CT scans Blood vessels and nerves

Treatment…. Nonsurgical Stable fracture Use of crutches or walker Partial weight bearing up to 3 months

Treatments… Surgical Unstable fractures External fixator Traction Plates and screws

Outcomes…. Stable vs. non-stable Gait Subsequent Problems pain Impaired mobility Sexual dysfunction

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