Lower limb fractures & Dislocations

1. Lower limb fractures & Dislocations

2. Topics Pelvic Fractures. Hip Dislocations. Proximal femoral fracture. Femoral Shaft Fractures. Fracture tibial plateau. Tibial shaft Fractures. Ankle fractures.

3. 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.

4. Management The proper way to treat a patient with high energy trauma is to look at the patient as whole, not to injured limb alone! So the aim to treat such patient is to save life first, then save limb, finally to save function. A.B.C.D

5. Pelvic Fractures Pelvic fracture is a high energy trauma, as a result of car accident, fall. Classifications. (Tile) Type A. Stable A 1. Fractures of the pelvic not involving the Ring. A 2 . Stable, minimally displaced fracture of the Ring .

10. Type B. Rotationally Unstable,Vertically Stable. B1. Open Book B2 . Lateral Compression: Ipsilateral B3. Lateral Compression: Contra lateral

11. Type C. Rotationally and Vertically Unstable C1 . Unilateral C2 . Bilateral C3 . Associated with Acetabular Fracture

12. MANEGEMENT Aggressive treatment. Obtain X-Ray: AP pelvic, Inlet, outlet, Ct Scan.

17. Treatment Aggressive treatment . By A.B.C.D. Obtain X-Ray: AP pelvic, Inlet ,outlet Ct Scan. Think in systemic approach. Specific treatment: Type A . symptomatic treatment Type B .ORIF with plates& screws, External Fix. Type C. ORIF with plates & screws. Both AP.

18. Emergency treatment Protect primary blood clot by early pelvic splintage and prevention of exessive movement Fluids, early blood transfusion, early fresh frozen plasma, platelets, cryoprecipitate Prevent hypothermia and acidosis Stop other bleeding sites Stabilize pelvis

23. complications Hemorrhage – life threatening Bladder/bowel injuries Neurological damage Obstetrical difficulties Persistent Sacro-iliac joint pain Post –traumatic arthritis of the hip with acetabular fractures

24. Acetabular fracture Usually it is a result of high- energy trauma. The acetabulum is divided into four segments—an anterior column and wall (rim) and a posterior column and wall (rim). Fractures of the acetabulum are classified based on their involvement of these structures .

26. classification Letournel and Judet

27. Investigation AP pelvis. Judat views ( Internal Oblique, Obturator view) CT scan .

33. TREATMENT Indications for Nonoperative Treatment 1. Nondisplaced and Minimally Displaced Fractures. 2. Fractures with Significant Displacement but in Which the Region of the Joint Involved Is Judged To Be Unimportant Prognostically 3. Secondary Congruence in Displaced Both-Column Fractures

34. Medical Contraindications to Surgery Local Soft Tissue Problems, Such as Infection, Wounds, and Soft Tissue Lesions from Blunt Trauma. Elderly Patients with Osteoporotic Bone in Whom Open Reduction May Not Be Feasible. Skeletal traction for 4-6 weeks. And then start physiotherapy in bed.

35. Operative Treatment Indications for Operative Treatment. 1. An acetabular fracture with 2 mm or more displacement in the dome of the acetabulum. 2. Any subluxation of the femoral head from a displaced acetabular fracture noted on any of the three standard roentgen graphic views

42. Complications posttraumatic arthritis in 17%. a vascular necrosis after posterior dislocation was 7.5%. Infections are reported to occur in 1% to 5% Sciatic nerve palsies as a result of the initial injury occur in approximately 10% to 15%. Heterotopic ossification (HO) occurs after most extensile approaches

43. HIP Dislocations

44. Mechanism of AnteriorDislocation Extreme abduction with external rotation of hip. Anterior hip capsule is torn or avulsed. Femoral head is levered out anteriorly.

45. Physical Examination: Classical Appearance Posterior Dislocation: Hip flexed, internally rotated, adducted.