Lower Limb Fracture revision material.pptx

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1. Fractures Lower Limb

2. Fracture of Pelvis Classification: Isolated # with intact pelvic rim # with disruption of Pelvic ring # of acetabulum # of sacrum & Coccyx Mechanism of Injury Anterior posterior compression- open book injury Lateral compression- # of pubic rami, SI joint sacrum ilium Vertical shear; # of pubic rami+ SI disruption Combination

3. Management Closed reduction + hip spica Open book # - Elastic girdle, 8 weeks + 2weeks of PWB Traction: Closet for pelvis, Long traction for tibia, 8 weeks + 2 weeks bed mob, Internal Fixator: Plate and screws, K wire 3 weeks ( imm ) + 3 week (bed mob) External Fixator ( Hoffmans ) 3 weeks + 3weeks, PWB

4. Femoral Neck # Definition: A femoral neck fracture is a fracture occurring proximal to the intertrochanteric line in the intracapsular region of the hip Gardens Classification: type 1: an incomplete impacted femoral neck fracture in valgus position. All femoral neck fractures are intracapsular. – (Conservative Hip Spica) type 2: nondisplaced complete femoral neck fracture. (DHS or multiple cannulated screws) type 3: displaced femoral neck fracture in varus position. There is often disruption of the joint capsule. (Conservative, Hip spica, Surgery) type 4: completely displaced femoral neck fracture. (Conservative, Hip spica, Surgery)

5. Expected Time of Bone Healing Twelve to 16 weeks. Expected Duration of Rehabilitation Fifteen to 30 weeks.

6. Rehab

7. LONG-TERM CONSIDERATIONS AND PROBLEMS Avascular necrosis of the femoral head may require prosthetic replacement if it becomes symptomatic and causes pam. Nonunion may require prosthetic replacement of the femoral head and neck. Leg-length discrepancy is rare, but may be a longterm problem requiring a shoe lift. Prominent and painful screws, pins, and plates may require removal.

8. Intertrochanteric Fractures Definition An intertrochanteric fracture is a fracture occurring between the greater and lesser trochanters along the intertrochanteric line, outside of the hip joint capsule. Expected Time of Bone Healing: Twelve to 15 weeks.

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10. Subtrochanteric Femur Fractures Definition Subtrochanteric fractures occur between the lesser trochanter and the adjacent proximal third of the femoral shaft. They may extend proximally to the intertrochanteric region Mechanism of Injury: These fractures may result from high-energy trauma in young patients or from distal extension of intertrochanteric fractures in elderly patients.

11. Expected Time of Bone Healing: Twelve to 16 weeks. Expected Duration of Rehabilitation: Sixteen to 20 weeks.

12. Femoral Shaft Fractures Definition A femoral shaft fracture is a diaphyseal fracture of the femur that does not extend into the articular or metaphyseal region Winquist Classification: T0: Nondisplaced # with no butterfly fragment Type 1: Small separate piece of bone T2: Larger butterfly fragment but cortex is at least 50% intact T3 Larger butterfly fragment T4: Severe commination with no cortical abutment

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14. Supracondylar # Definition A supracondylar femur fracture involves the distal aspect or metaphysis of the femur. This area includes the distal 8 to 15 cm of the femur. The fracture frequently involves articular surfaces. Muller’s Classification: extraarticular (type A), unicondylar (type B), bicondylar (type C).

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16. Patellar Fractures Definition Patellar fractures are classified as either nondisplaced or displaced. Those that are less than 1 to 2 mm articular step-off or 3 mm of fragment separation displaced are considered nondisplaced fractures. Classification Patellar fractures may also be described as transverse, longitudinal, or comminuted

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18. Tibial Plateau Fractures Definition Tibial plateau fractures involve the proximal aspect or metaphysis of the tibia and frequently the articular surface as well. Schatzkar Classification: Type I is a wedge or split fracture of the lateral tibial plateau. Type II is a split depression fracture of the lateral plateau and involves an articular injury Type III is a pure depression fracture of the lateral plateau that also involves an articular injury Type IV is a split depression fracture of the medial tibial plateau, often involving the intercondylar eminence and associated cruciate ligament. It is usually associated with an articular injury Type V is a bicondylar fracture involving both plateaus. It is also known as an inverted Y fracture and is usually associated with an articular injury Type VI is a fracture at the proximal tibial diaphyseal-metaphyseal junction

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20. Tibial Shaft Fractures Definition: A tibial shaft fracture is a diaphyseal fracture of the tibia that does not usually involve the articular or metaphyseal region.

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22. Ankle Fractures Definition: Ankle fractures include fractures of the medial and lateral malleoli as well as the distal articular surface of the tibia and fibula. Classification: Isolated lateral malleolar fractures Bimalleolar fractures Medial malleolar fractures Bimalleolar equivalent fractures , in which the lateral malleolus is fractured and the medial side of the ankle mortise is widened Trimalleolar fractures (intraarticular), involving the medial and lateral malleolus as well as the posterior aspect of the tibial plafond

23. Mechanism of Injury: Relatively low-energy forces, due to actions such as tripping on or twisting an ankle, are the most common cause of ankle fractures. Direct or indirect high-energy forces, such as those incurred in motor vehicle accidents, can also cause ankle fractures. Such fractures are often associated with significant soft-tissue injuries as well as dislocation of the ankle joint. The pattern of ankle injury depends on the position of the foot at the time of injury, which can be in either supination or pronation

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25. Talar # Definition: Fractures of the hindfoot are those involving the calcaneus ( os calcis ) and the talus. Fractures of the talus include fractures of the talar neck, the talar body, or the talar head, as well as osteochondral fractures and fractures of the lateral process

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27. Calcaneal # Definition: Fractures of the hindfoot are those involving the calcaneus ( os calcis ) and the talus or any of its processes. Mechanism of Injury: Calcaneus ( os calcis ) fractures are often caused by a sudden, high-velocity impact on the heel, such as in a motor vehicle accident or landing from a fall of 3 feet or more directly onto the heel.

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