FRACTURES 0F LOWER LIMB

1. FRACTURES 0F LOWER LIMB BY Vishnu Mohan

2. Topics • Mechanism of fractures • fracture of femur • fracture of patella • Tibial and fibular Fractures. • Ankle fractures • fracture of foot • Fracture of pelvis.

3. fractures A bone fracture is a medical condition in which there is a break in the continuity of the bone

4. Types Closed{simple} open{compound} Compression Complete Incomplete Linear Transverse Oblique Spiral Impacted comminuted

9. Mechanism of fractures • Lower limb fracture is a result of a high energy trauma except in elderly people or diseased bones • Types of fracture are depend on position of limb during impaction and magnitude of forces applied.

10. femur • Upper end • shaft • Lower end

11. Fractures of head of femur • The head and neck of the femur is primarily intended for transmission of body weight efficiently with minimum bone mass.

12. - Mechanism : - Minimal trauma in old people with osteoporosis - High energy trauma in young adults .

13. Types Intracapsular Extracapsular

14. Intracapsular types subcapital- just distal to femoral head Transcervical– at the middle of femoral neck

15. Extracapsular types Intertrochanteric- passes between two trochanterspertrochanteric –passes through the two trochanters,one or both of which may be seperated Subtrochanteric -2or3 inches below lesser trochanter

17. incomplete fracture of the neck (so called abducted or impacted)

18. complete without displacement

19. 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

20. - 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

21. Arthroplasty Surgical reconstruction or replacement of degenerated joint

22. Examples of Internal Fixation

23. 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 .

24. 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.

25. External fixator

27. splint a rigid or flexible appliance for fixation of displaced or movable parts Thomas splint A 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.

28. (B), Thomas knee splint.

29. PATELLAR FRACTURES

30. The patella, also known as the knee cap or kneepan circular-triangular bone  It is the largest sesamoid bone in the human body.

31. PATELLAR FRACTURES Caused by direct injury or by indirect injury The type of fracture is different in both Treatment is also different

32. Types 1.direct [stellate] 2.indirect [transverse]

33. 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

34. 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.

35. 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

36. pattellectomy An operation to remove the patella.

37. Indirect Inspection- there is swelling but is less than direct fracture Mechanism- when a person slips on leg with the other leg in a semi flexed position 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

38. Treatment 1.Undisplaced crack fracture by plaster cylinder 2.With separation{in middle} a) internal fixation b) patellectomy

40. Fracture Tibia & Fibula: - Mechanism : -Direct trauma , falling . - Management : - Closed reduction & cast immobilization . - Open reduction internal fixation by plate and screws or inter locking nail .

43. Tibial and fibular fractures

44. Fractures of the Ankle

45. Fractures of the Ankle • Classification : - 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

47. Examples of Internal Fixation

48. Fractures of foot

50. Fractures of calcaneum Mechanism - fall from height degree of displacement also varies according to the violence Types Chip fractures- rare type Split fractures- split in to two fragments Crush fractures- the portion which articulates with talus is completely crushed