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

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

GARDEN CLASSIFICATION

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

FEMUR INTERTROCAHNTERIC #”S

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

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

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

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

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

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

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

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

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

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

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

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

TIBIA FRACTURES PROXIMAL • CLASSIFICATION- Schatzker Classification

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

QUESTIONS • THANK YOU

FEMUR, KNEE, PATELLA AND TIBIAL PLATEAU FRACTURES