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FEMUR, KNEE, PATELLA AND TIBIAL PLATEAU FRACTURES

Orthopaedics Department. FEMUR, KNEE, PATELLA AND TIBIAL PLATEAU FRACTURES. H. Sithebe. FEMUR FRACTURES. Femur Head Femur Neck Intertrochanteric Subtrochanteric Shaft Supracondylar Condylar. FEMUR NECK FRACTURES. CAUSES CLINICAL PRESENTATION CLASSIFICATION MANAGEMENT.

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FEMUR, KNEE, PATELLA AND TIBIAL PLATEAU FRACTURES

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  1. Orthopaedics Department FEMUR, KNEE, PATELLA AND TIBIAL PLATEAU FRACTURES H. Sithebe

  2. FEMUR FRACTURES • Femur Head • Femur Neck • Intertrochanteric • Subtrochanteric • Shaft • Supracondylar • Condylar

  3. FEMUR NECK FRACTURES • CAUSES • CLINICAL PRESENTATION • CLASSIFICATION • MANAGEMENT

  4. FEMUR NECK FRACTURES • Common-Elderly patients, Caucasians, women , Ass medical conditions • CLASSIFICATION-Garden- Dis /Undisplaced -Intra/ extra capsular

  5. GARDEN CLASSIFICATION

  6. FEMUR NECK FRACTURES • Displaced – young patient- ORIF -Older patient- Arthroplasty • Undisplaced- ORIF • Complications - AVN - young • Cx Elderly-Confusion, Electrolyte imbalances, UTI ,Pneumonia, pressure sore etc • Q-within 4 days

  7. FEMUR INTERTROCAHNTERIC #”S

  8. FEMUR INTERTROCAHNTERIC #”S • Risk Factors- • Osteoporosis, medical co morbidities , positive maternal history • Classification – • Stable / Unstable • Stable- 2 part, sustains medial compressive forces • Unstable- 3 part, Falls into Varus, cannot sustain -Reverse oblique

  9. FEMUR INTERTROCAHNTERIC #”S • MANAGEMENT • Resuscitate patient • Consult Physicians and Anaesthetist • Planned surgery within 4 days • DHS, Cephalo medullary Device- choose according to # pattern

  10. FEMUR INTERTROCAHNTERIC #”S • Early-mentioned before • Late -Implant failure, Infection , -Mortality , Leg length discrepancy

  11. SUBTROCHANTERIC FRACTURES • Causes- High E transfer –Young Pts • Anatomically- 5cm below the lesser trochanter • Forces acting- PICTURE

  12. SUBTROCHANTERIC FRACTURES • MANAGEMENT-ABC • ORIF • Complications- Non Union –Watershed area -Mal Union & same

  13. FEMUR SHAFT • CAUSES-High E Trauma • CLINICAL PRESENTATION • -Isolated/ Poly Trauma • Leg shortened external rotation • Pain etc • CLASSIFICATION-Pattern of Fracture

  14. FEMUR SHAFT MANAGEMENT • ABC • Prevent possible complications eg Fat embolism Sx • Exclude ass #”s-3% neck #- 30% missed • Exclude ass Knee Injuries- 10% LIGAMENT Injuries • IM Nail= ORIF

  15. FEMUR DISTAL • CAUSES-Same • CLINICAL PRESENTATION-Swelling, Pain etc -NB! –Vascular injury • CLASSIFICATION • Supracondylar (Extra-articular ) • Intercondylar(Intra-articular )

  16. FEMUR DISTAL • MANAGEMENT • ABC • Exlude Popliteal Art Injury • ORIF • Early Knee ROM

  17. PATELLA FRACTURES • CAUSES- Direct or avulsion • CLINICAL PRESENTATION • Same all trauma • Specific- Inability to extend the Knee • Evaluate the Iliotibial tract and Patella Retinaculum • Old- tendon intra substance tear • Young-Avulsion injuries

  18. PATELLA FRACTURES • CLASSIFICATION • Transverse • Vertical • Comminuted • MANAGEMENT • Displaced -2mm step, 3mm apart-ORIF • Undisplaced-Ranger Brace 6 weeks

  19. TIBIA FRACTURES PROXIMAL • CAUSES- High E Transfer -Axial loading with either Varus - or Valgus stress • CLINICAL PRESENTATION • -Same Trauma • -Specific evaluate Vascular Injury • - ass ligament injuries

  20. TIBIA FRACTURES PROXIMAL • CLASSIFICATION- Schatzker Classification

  21. TIBIA FRACTURES PROXIMAL • MANAGEMENT • ABC • Evaluate axial skeleton • Stabilise • Definitive-ORIF

  22. QUESTIONS • THANK YOU

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