1. LOWER LIMB FRACTURE Complications Professor Jegan Krishnan Flinders University Adelaide, South Australia Specialists Without Borders Seminar in Surgery Rwanda, September 2010

2. www.specialistswithoutborders.org Learning Objectives  Identifying the common lower limb fracture complications  Early assessment and management  Prevention of complications

3. www.specialistswithoutborders.org Infection  Infection at fracture prevented by early and maticulouss debridement  Early appropriate antibiotics  Fracture stabilisation  Soft tissue coverage

4. www.specialistswithoutborders.org Compartment Syndrome  Most common fracture complication missed  Early assessment  Clinical features  Compartment Pressure Measurements  Early Fasciotomy

5. www.specialistswithoutborders.org Vascular Injury  Early recognition  Early Investigation  Vascular Surgery Consultation  Reanastomosis

6. www.specialistswithoutborders.org Vascular Injury

7. www.specialistswithoutborders.org Neurological Injury  Early assessment both pre-reduction and post reduction  Majority of injuries are neuropraxia  When to explore is a tricky decision

8. www.specialistswithoutborders.org Neuropraxia  Early recognition  Determine level of injury  Observe recovery rate  Nerve conduction test and EMG  Explore if recovery rate not progressing as expected

9. www.specialistswithoutborders.org Non Union  Definition  Types – Hypertrophic – Atrophic  Management – Stabilisation – Bone Grafting

10. www.specialistswithoutborders.org Malunion  Definition  Management

11. www.specialistswithoutborders.org SUMMARY  Best management is prevention  Early suspicion  Early recognition  Early correction  Late corrective options are available