BY
FRACTURES 0F LOWER LIMB
Vishnu Mohan
Topics
• Mechanism of fractures• fracture of femur• fracture of patella• Tibial and fibular Fractures.• Ankle fractures• fracture of foot• Fracture of pelvis.
fracturesA 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 fracturesLower limb fracture is a result of a high energy trauma except in elderly people or diseased bonesTypes of fracture are depend on position of limb during impaction and magnitude of forces applied.
femur
Upper end shaftLower end
Fractures of head of femurThe 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 .
Types
IntracapsularExtracapsular
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
- 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
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 splintA 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
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
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. 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 AnkleClassification :
- 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
TypesChip 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. (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
Diagnosis…
X-RaysCT 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-stableGaitSubsequent Problems
pain–Impaired mobility
Sexual dysfunction
Thank you
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