Scribd Logo
Upload

Welcome to Scribd!

  • 210 views

    Lower Limb Fractures

    Uploaded by

    Anda Madalina Zaharia
    This document discusses various lower limb fractures. It describes fractures of the distal femur, patella, tibial plateau, tibial shaft, ankle, and calcaneus. For each fracture type, the document discusses anatomy, mechanisms of injury, classification systems, clinical presentation, imaging, complications, and treatment options including closed or open reduction with internal fixation or external fixation. Surgical treatment goals are to restore joint congruity and stability.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd

    Lower Limb Fractures

    Uploaded by

    Anda Madalina Zaharia
    210 views120 pages
    This document discusses various lower limb fractures. It describes fractures of the distal femur, patella, tibial plateau, tibial shaft, ankle, and calcaneus. For each fracture type, the document discusses anatomy, mechanisms of injury, classification systems, clinical presentation, imaging, complications, and treatment options including closed or open reduction with internal fixation or external fixation. Surgical treatment goals are to restore joint congruity and stability.

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses various lower limb fractures. It describes fractures of the distal femur, patella, tibial plateau, tibial shaft, ankle, and calcaneus. For each fracture type, the document discusses anatomy, mechanisms of injury, classification systems, clinical presentation, imaging, complications, and treatment options including closed or open reduction with internal fixation or external fixation. Surgical treatment goals are to restore joint congruity and stability.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    210 views120 pages

    Lower Limb Fractures

    Uploaded by

    Anda Madalina Zaharia
    This document discusses various lower limb fractures. It describes fractures of the distal femur, patella, tibial plateau, tibial shaft, ankle, and calcaneus. For each fracture type, the document discusses anatomy, mechanisms of injury, classification systems, clinical presentation, imaging, complications, and treatment options including closed or open reduction with internal fixation or external fixation. Surgical treatment goals are to restore joint congruity and stability.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 120

    LOWER LIMB FRACTURES

    DR. CODRIN HUSZAR University Hospital Bucharest

    DISTAL FEMORAL FRACTURES

    Ethiology

    High energy trauma young / active patients (dashboard impact) Low energy trauma elderly (falls from the same level)

    CLASSSIFICATION (A.O. / O.T.A.)


    A SUPRACONDYLAR (EXTRAARTICULAR) B UNICONDYLAR (PARTIAL ARTICULAR) C SUPRA- AND INTERCONDYLAR

    DISPLACEMENT

    CLINICAL PRESENTATION

    Swelling and regional deformity Patellar shock present

    COMPLICATIONS

    IMMEDIATE
    Open Fx. Neuro-vasc injuries Soft tissue entrap.

    EARLY
    DVT Infections

    LATE
    NonUnion MalUnion Arthritis Joint stiffnes

    TREATMENT SUPRACONDYLAR Fx.

    CLOSED REDUCTION & INTERNAL FIXATION : RETROGRADE NAILING (RETRONAIL)

    (+/- OPEN REDUCTION & INTERNAL FIXATION)

    TREATMENT SUPRACONDYLAR Fx. RETROGRADE NAIL

    TREATMENT SUPRACONDYLAR Fx.

    10

    TREATMENT SUPRACONDYLAR Fx.

    11

    TREATMENT SUPRA- AND INTERCONDYLAR Fx.

    OPEN REDUCTION & INTERNAL FIXATION :

    Plate and screws


    DCS (Dynamic Condylar Screw) A.O. Blade - Plate
    12

    TREATMENT SUPRA- AND INTRACONDYLAR Fx.

    13

    TREATMENT SUPRA- AND INTRACONDYLAR Fx.

    14

    TREATMENT SUPRA- AND INTRACONDYLAR Fx.

    15

    TREATMENT SUPRA- AND INTRACONDYLAR Fx.

    16

    TREATMENT UNICONDYLAR Fx.

    ORIF : screws / plate and screws

    17

    FRACTURES OF THE PATELLA


    18

    Anatomy. Function

    Largest sesamoid bone Part of the femoro patellar joint (posterior


    aspect : articular surface divided into medial and lateral facets by longitudinal ridge; distal pole nonarticular

    Part of the knee extensor mechanism

    19

    MECHANISM OF INJURY

    Direct / Indirect (avulsion)

    20

    CLASSIFICATION

    21

    22

    23

    24

    Physical Examination

    Pain, swelling, contusions, lacerations and/or abrasions at the site of injury Palpable defect Assessment of ability to extend the knee against gravity or maintain the knee in full extension against gravity

    25

    TREATMENT GOALS

    Restore extension function Restore articular congruency

    26

    TREATMENT ALGORITHM
    FRACTURE TYPE NonDisplaced ( Extension ) INDICATION Orthopedic

    Displaced fractures
    Inferior pole fx.

    ORIF
    Polar patelectomy + patellar td. reinsertion

    Severe cominution, elderly Osteo-chondral fx.

    Total patelectomy Excision / fixation

    27

    ORTHOPEDIC TREATMENT

    Long leg (femoro-tibial) cylinder cast for 4-6 weeks

    28

    SURGICAL TREATMENT Tension Band Wiring

    29

    30

    COMPLICATIONS

    Open fx. Infection Malunion Femoro-patellar arthritis Joint stifness Hardware failure

    31

    TIBIAL PLATEAU FRACTURES

    32

    Anatomy

    Proximal Tibia widens into lateral and



    medial tibial flares flares lead to medial and lateral plateau (condyles) intercondylar eminence tibial tubercle (patellar td.) Gerdys tubercle (ITB) proximal tib/fib joint

    33

    Mechanism

    Low energy trauma : valgus-stress (elderly) lateral plateau fx. High energy trauma : associated mechanisms (falls from height, MVA etc.) complex fx.

    34

    Schatzker I Split type

    35

    Schatzker III Depression type

    36

    Schatzker II Split depression type

    37

    Schatzker IV Medial condyle fr.

    38

    Schatzker V Bicondylar fr.

    39

    Schatzker VI Bicondylar fr. with physeal diaphyseal dissociation

    40

    Physical examination

    Painfull weight bearing Hemarthrosis (swelling, patelar shock present) Knee stability evaluation Vascular evaluation ( ! posteriorly displaced fragments) Neurologic evaluation (peroneal nerve) ! Compartment syndrome Blisters

    41

    Computed Tomography

    42

    Complications

    IMMEDIATE

    EARLY
    Comp . Sdr.

    LATE
    MalUnion Arthritis Joint instability Joint stiffnes

    Neuro-vasc injuries Blistering DVT Infections

    43

    Treatment options

    Nondisplaced (elderly) Orthopedic Treatment :


    above the knee cast 6 8 weeks no weight bearing

    Displacd : Surgical Treatment ORIF

    44

    SURGICAL TREATMENT GOALS

    RESTORE JOINT CONGRUITY

    RESTORE JOINT STABILITY

    45

    SURGICAL TREATMENT SCHATZKER I

    46

    SURGICAL TREATMENT SCHATZKER III

    47

    SURGICAL TREATMENT SCHATZKER II

    48

    SURGICAL TREATMENT COMPLEX FRACTURES

    49

    SURGICAL TREATMENT COMPLEX FRACTURES

    50

    TIBIAL DIAPHYSEAL FRACTURES


    51

    Introduction

    492,000 per year (incidence) Injury mechanism (direct / indirect, high trauma) : MVA sport injuries falls gunshot injuries

    52

    Physical Exam

    Pain, inability to bear weight, and deformity may be seen


    Local swelling and edema variable Careful inspection of soft tissue envelope necessary, including compartment swelling Thorough neurovascular assessment including motor/sensory exam and distal pulses

    53

    Physical Exam

    Soft tissue injury with high-energy crush mechanism may take several days to fully declare itself
    Repeated exam often necessary to follow compartment swelling

    54

    COMPLICATIONS

    IMMEDIATE
    Open fracture Neuro-vascular injuries

    EARLY
    Compartment sdr. Soft tissue problems Infection DVT

    LATE
    Delayed- / Nonunion Malunion

    55

    Treatment

    Surgical (apart from nondisplaced fx.) CRIF : centromedullary nails

    56

    57

    58

    59

    60

    61

    Open fractures

    (~)

    Gustilo Anderson classification


    Criteria : - trauma energuy - soft tissue staus - bacterial contamination

    62

    Open fractures

    Type I
    - low energy - wound ~ 1 cm. - minimal contamination

    63

    Open fractures

    Type II - medium energy - wound > 1 cm. - no devitalised tissues - medium contamination

    64

    Open fractures
    Type IIIA - high energiy - extensive lacerations and soft tissue devitaliation - important contamination - ! posible coverage of the fracture site

    65

    Open fractures

    Type IIIB -fracture site exposure, periostal stripping - gros contamination

    66

    Open fractures

    Type IIIC = type IIIB + arterial lesions

    limb salvage procedures or amputation

    67

    Open fractures

    TREATMENT Issues = wound closure = fracture fixation

    68

    Open fractures

    TREATMENT WOUND = excision = debridement = fracture coverage * suture * flaps (* epitelisation per secundam) = ATPA, AB, antigangrenous serum

    69

    Open fractures

    TREATMENT Fracture fixation = intramedulary nails ( I, II, +/-IIIA?) = external fixation

    70

    External fixation

    71

    ANKLE FRACTURES (MALLEOLAR FRACTURES)

    72

    Ankle Anatomy

    Complex joint comprising the articulation of the tibia and fibula with the foot at the talus Intrinsic stability arises from congruous bony articulations and muscular forces across the ankle Extrinsic stability arises from the medial and lateral ligament complex and capsule Relatively thin soft tissue envelope
    73

    74

    MECHANISM OF INJURY

    Indirect (complex abnormal rotation)

    Inversion

    Eversion
    75

    RADIOLOGIC ASSESMENT

    MORTISE VIEW (15 INT. ROT.) LATERAL VIEW

    76

    Tibiofibular overlap
    <10mm is abnormal implies syndesmotic injury

    Tibiofibular clear space


    >5mm is abnormal implies syndesmotic injury

    77

    78

    < 1 mm overlap

    Medial joint space widening

    Deltoid lig. injury

    79

    CLASSIFICATION - DESCRIPTIVE

    80

    Weber (Duparc) CLASSIFICATION

    Weber C fibula proximal to mortise

    Weber B fibula at level of mortise

    Weber A fibula distal to mortise Concept - the higher the fibula the more severe the injury
    81

    CLASSIFICATION

    STABLE UNSTABLE : > 2 LESIONS TALAR DISLOCATION

    82

    83

    COMPLICATIONS

    IMMEDIATE
    OPEN Fx. (medial)

    EARLY
    Soft tissue problems Infections DVT

    LATE
    Nonunion Malunion Arthritis Ankle instability SRD
    84

    85

    TREATMENT OPTIONS

    STABLE : orthopedic treatment UNSTABLE (Ist step repositioning of the talus) : Orthopedic treatment CR (talus perfecty centered) + Imob. or Surgical treatment : ORIF

    86

    Orthopedic treatment
    Reduction + XRay assesment

    Above-the-knee cast 6 weeks

    No weight bearing Weekly XRay reviews (Ist month)

    Below-the-knee cast 4 weeks Progressive weight bearing


    87

    Surgical treatment

    Lateral maleollus : plate and screws Medial malleolus : screws / tension band wiring Posterior malleolus : screws Sindesmotic injuries : screws

    88

    89

    90

    91

    ANKLE FRACTURES (TIBIAL PLAFOND

    FRACTURES)
    92

    Introduction

    Terrible Injuries (High Trauma)


    Mechanism Axial Loading Severe soft tissue problems Excellent Results are rarely achieved Fair-Good results are the norm Treatment complications must be avoided

    93

    94

    95

    96

    Current Spectrum of Treatment Techniques


    Spanning External Fixation Ext. fixation + Percut. screws
    Internal Fixation with Plates and screws

    97

    IF : Plate & Screws

    98

    EF + percutaneous screws

    99

    100

    FRACTURES OF THE CALCANEUS


    101

    Introduction

    High potential for disability


    Pain Gait disturbance Unable to work

    Best treatment method controversial

    102

    Anatomy

    Calcaneocuboid

    103

    Ant. Middle
    Anatomy:
    Facets of ST Joint

    IO lig.
    Post.

    Tub.
    104

    Hindfoot Function

    Calcaneus Lever arm powered by gastrocnemius Foundation for body wt. Supports/ maintains lat. column of foot

    105

    Classification

    According to the involvement of the subtalar joint : Intraarticular fractures Extraarticular fractures

    106

    Mechanism

    Falling from some height

    107

    Clinical presentation

    Intense swelling Hindfoot deformity : decreased height / increased width / valgus deformity Early plantar echimosis Blistering, ischemia, skin necrosis ! Compartment syndrome

    108

    109

    Complications

    Early : Soft tissue problems Compartment syndrome Wound healing problems / infection

    110

    Complications

    Malunion Stiffness

    Loss of normal gait Shoewear problems Arthritic pain Sympathic Reflex Distrophy

    111

    Imagistic assesment

    lateral XRays + CT scan :

    112

    CLASSIFICATION - BHLER

    Bohlers Angle

    113

    CLASSIFICATION - BHLER

    114

    Orthopedic treatment

    Indications : Non- or minimally displaced fractures CI to surgery :


    soft tissue complications
    diabetes peripheral vascular disease elderly, with severe medical problems severly cominuted fx. + inexperienced surgeon
    115

    Orthopedic treatment

    Below-the-knee (Graffin type) plaster cast for ~ 6 weeks

    116

    Surgical treatment

    Goals :

    Restoring subtalar joint congruence Restoring height and orientation of the hindfoot

    117

    Surgical treatment OR + grafting + IF

    118

    Surgical treatment

    119

    The End (Sfarsit)


    The End

    120

    You might also like