Lower limb fractures

Femur

Tibia and Fibula

Patella

Ankle

Calcaneal

Metatarsals

Lower limb fractures

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' (NOF).

Extra Capsular

Intertrochanteric

Subtrochanteric

Shaft

Distal end

Supracondylar

Condylar

Intracapsular fracture – Subcapital

Intertrochanteric fracture

Subtrochanteric fracture

The Garden classification of femoral neck fractures

Based on the degree of displacement on the anteroposterior

radiographs.

Differentiation has therapeutic as well as prognostic value.

Type I and II fractures have a low incidence of avscular

necrosis .

Grading

Grade 1: incomplete impacted fracture of the femoral neck.

Grade 2: complete undisplaced fracture.

Grade 3: complete fracture with moderate displacement.

Grade 4: severely displaced fracture.

Pauwels classification Pauwels classification refers to the angle the fracture line

makes with the horizontal

Grade 1 Grade 2 Grade 3

Garden….?

Grade 1

Garden…?

Grade 4

FEMORAL SHAFT FRACTURES

Femoral fractures require high force trauma

Pathological fractures in old osteoporotic

AP and lateral views

Spiral fracture with posterior angulation, lateral displacement and shortening

Pathological femoral shaft fractureTransverse fracture with rotational displacement and shortening

Fractures of lower end of femur

Extra-articular or supracondylar in which the fracture does not extend to the knee joint line.

Partial-articular / condylar

The fracture extends to the knee joint line but part of the

condyles remain attached to the femur shaft.

Complete-articular or intercondylar

The fracture extends to the knee joint line but the

condyles are completely separated from the femur

shaft.

Supracondylar Fractures

The lower fragment is drawn backward by the gastrocnemius

and plantaris, and the popliteal vessels and internal popliteal

nerve may either be wounded or stretched over its sharp

upper edge. The artery lying deepest is the most liable to

injury, then the vein, and finally the nerve.

Supracondylar fracture

Fracture medial condyle

Bipartite patella

Patellar fracture- haemarthrosis

Tibial plateau fracture

Stress fractures

Toddlers fracture

Tibial plateau fractures

Fractures of the tibial plateau can be subtle or wide

displacement with varying degrees of comminution.

There may be depression of the plateau surface,

displacement of a fracture fragment or both.

Lipohaemarthrosis.

Lateral tibial plateau fractureThe fracture fragment is displaced and depressed from its normal position

Depressed tibial plateau contour- Lipohaemarthrosis

Tibial and fibular fracture

Tibial stress fracture

Toddler's fractureFine spiral line through the tibial shaft

ANKLE FRACTURES

Lateral malleolar fractures

Lateral malleolar fractures are categorized according to their

position in relation to the distal tibiofibular syndesmosis at

the level of the ankle joint.

Weber fracture classification

Weber A = Distal to ankle joint

Weber B = At level of ankle joint

Weber C = Proximal to ankle joint

Lateral malleolus fracture(Weber A)

Findings & Weber…?

Bimalleolar fracture (Weber B)

Trimalleolar fracture

Maisonneuve fracture

Spiral fracture of the proximal third of the fibula associated

with a tear of the distal tibiofibular syndesmosis and the

interosseous membrane.

There is an associated fracture of the medial malleolus or

rupture of the deep deltoid ligament.

Maisonneuve fracture

Osteochondral Fractures

Occasionally ankle trauma causes a fracture of the

talus bone surface. These 'osteochondral' injuries are

often subtle and so this area should be assessed

carefully on all post-traumatic ankle X-rays.

Osteochondral fractureLoss of the normal talar dome cortex contour due to an osteochondral fracture

Calcaneal Fractures

Falling from height can lead to severe calcaneal fractures,

which may be accompanied by axial loading fractures of the

spine.

Calcaneal fractures due to a fall from height are often

comminuted and intra-articular.

Bohler’s Angle

A line is drawn from the tuberosity to the most superior part

of the posterior facet.

Another line is drawn from the most superior part of the

facet to the anterior process.

Normally the angle created is between 20 and 40 degrees.

If the angle is less than 20 degrees, this indicates depressed

fracture.

Bohler’s Angle

The critical angle of Gissane

It is formed by a line along the lateral margin of the posterior

facet and another line extending anterior to the beak of the

calcaneus. The normal value is 95 to 105 degrees with an

increase representing posterior facet collapse

Types of calcaneal fractures

Intra and Extrarticular fractures on the basis of subtalar joint

involvement.

Intrarticular fractures are more common and involve the

posterior talar articular facet of the calcaneus.

Extrarticular fractures are less common, and located

anywhere outside the subtalar joint.

The Sanders system classification

Is the most commonly used system for categorizing

intrarticular fractures.

Classifies these fractures into four types, based on the location

of the fracture at the posterior articular surface.

TYPES Type I fractures Type I fractures are non-displaced fractures (displacement <

2 mm).

Type II fractures Type II fractures consist of a single intrarticular fracture that divides the calcaneus into 2 pieces.

Type III fractures Type III fractures consist of two intrarticular fractures that divide the calcaneus into 3 articular pieces.

Type IV fractures Type IV fractures consist of fractures with more than three intrarticular fractures.

Metatarsal Fractures

Oblique fracture of 5th metatarsal shaft 5TH Metatarsal base fracture Metatarsal stress fractures

Stress fractures of the metatarsals are common in athletically active individuals. These may not be visible on initial X-rays but follow up images show periosteal stress reaction. This has the appearance of fusiform bone expansion.

NORMAL UNFUSED 5TH METATARSAL bone apophysis is aligned more longitudinally along the bone

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