Lower Limb Fractures

Mbanga, MD, Mmed

OT Surgeon
MZRH
 Lower limb fractures
• Femur
• Tibia and Fibula
• Patella
• Ankle
• Calcaneal
• Metatarsals
 FEMORAL FRACTURES
• Proximal end
• Shaft
• Distal end
 Proximal end
Intracapsular
• Capital : Fracture of the head
• Subcapital :below the femoral head
• Transcervical :across the mid-femoral neck
• Basicervical :across the base of the femoral
neck.
• These injuries (last three)may be correctly
termed fractures of the 'neck of femur
 Proximal end
Extra Capsular
• Intertrochanteric
• Pertrochateric
• Subtrochanteric
Shaft
Distal end
• Supracondylar
• Condylar
Intracapsular fracture – Subcapital
Pertrochanteric fracture
Subtrochanteric fracture
 Fracture Neck Femur
• Commonest fracture of lower limb in the
elderly
• Chances of nonunion is very high due to its
peculiar blood supply
• A trivial injury might cause this fracture due to
osteoporosis.
 Garden classification
• It is classified radiologically into four types
according to Garden in 1961
• Type1 incomplete impacted fracture
• Type2 complete but undisplaced fracture
• Type3 complete with moderate displacement
• Type4 severely displaced fracture
 Clinical features
• The affected limb is short and externally
rotated
• Pain and swelling at fracture site
• Can’t lift the affected leg
• Severe pain on movement
• Cant stand or put weight on affected limb
(except impacted fracture)
 Treatment
• Almost always surgical
• It depends upon age and type of fracture
• If age is above 60 the treatment is THA or
hemiarthroplasty, whatever the type of fracture
• If age is between 40 and 60 and it is type 3 or 4
fracture, treatment is compressional screws orTHA
• If age is between 40 and 60 and it is type 1 or 2
fracture, treatment is to reduce the fracture and fix
with cannulated screws, sliding screw or pin and
plate(DHS). Aim is to try to retain its original head
 Complications
• Nonunion
• Avascular necrosis of head of Femur
• Osteoarthritis of hip
Intertrochanteric/pertrochanteric
• As name indicates the fracture is in the
trochanteric region (greater and lesser
trochanters)
• 2nd commonest fracture of lower limb in
elderly
• Greater force is needed to cause this fracture
(as compared to neck Femur)
• Clinical feature:
• The affected limb is shorter and externally
rotated
• Pain and swelling at fracture site
• Pain on movement of leg
• Cant stand or put weight on affected leg
• Treatment
• In any type treatment is almost always internal
fixation with pin and plate(DHS) preceded by
closed or open reduction of fracture under
anaesthesia.
• Complications:
• Failed fixation
• Malunion
• Nonunion
 Subtrochanteric Fracture
• As name indicates the fracture is just below the
trochanters
• This fracture may occur with trivial injury
• The fracture is always considered as pathological
fracture until and unless proved otherwise
• Clinical features:
• The affected limb is shorter and externally rotated.
• Excruciating pain is noted
• Swelling is evident
• Movement of leg causes severe pain
• Treatment:
• Is almost always surgical.
• Open reduction under anaesthesia and internal fixation with
Pin and plate(DHS), DCS, Condylar plate or intramedullary
nail with or without a locking screw into the neck and head.
• Complications:
• Failure of implant
• Delayed union
• Malunion
• Nonunion
 FEMORAL SHAFT FRACTURES
• Commonly occurs in young adults
• Blood loss is severe
• Clinical features
• Pain and swelling at fracture site
• Patient may be in shock
• There may be associated injury
• Treatment
• Usually surgery
• Treat shock if any
• Immobilize the limb in a splint (Thomas splint)
• Definitive treatment is ORIF
• Implant used may be
• Interlocking Nail
• Broad Dynamic Compression Plate(DCP)
• K-nail
 Supracondylar and Condylar Fracture
• May occur in adults as well as in elderly
people
• In adults it needs a great force while in elderly
it can happen following a trivial injury due to
osteoporosis
• Pain and massive swelling at knee
• Danger of neurovascular injury, so always look
for distal pulses and nerves
• Treatment
• may be conservative or operative
• conservative treatment may be in the form of
traction and braces
• operative treatment in the form of ORIF and
the implant used may be Condylar plate or
Dynamic Condylar Screw(DCS)
• Complications
• Neurovascular injury
• Joint stiffness
• Delayed union
• Nonunion
Supracondylar and Condylar Fracture
• Patella is a sesamoid bone
• Fracture is usually transverse, it may be
undisplaced, displaced or communited
• Treatment
• is usually ORIF with wires in the form of
tension band wiring
• If it is communited, partial or total
patellectomy is advisable
 Fracture of Tibia
• It can be classified into three regions:
• Fracture of proximal Tibia (Tibial plateau
fracture)
• Fracture of shaft tibia
• Fracture of distal tibia
 Fracture Proximal Tibia
• Sometimes called bumper fracture
• It ranges from a simple to a very complicated
fracture
• It has been classified into 6 types according to
schatzker
• This fracture is notoriuos for neurovascular
injury, so it is always assessed thoroughly
(distal pulse should be palpated)
 Schatzker Classification of Tibial plateau
fractures
• I – Lateral split fracture
• II – Split-depressed fracture of lateral
• plateau
• III – Pure depression fracture of lateral
• plateau
• IV – Medial plateau fracture
• V – Bicondylar fracture
• VI – Metaphyseal-diaphyseal disassociation
Schatzker Classification of Tibial plateau
fractures
 Tibial Plateau Fracture
• Clinical Features:
• Pain and massive swelling noted at knee
• Popliteal artery, tibial and common peroneal
nerves should be examined
• Treatment:
• Complete anatomical reduction and early
movement at knee is mandatory
• Generally ORIF is done by means of L-plate,
screws or K-wires, but rigid fixation is required
 Tibial Plateau Fracture
• Complication:
• Compartment syndrome
• Stiffness of joint
• Deformity
• OA Knee
 Fracture Shaft Tibia and Fibula
• Commonest fracture in young adults
• Commonest fracture in motor bike drivers
• Compartment syndrome is common
• Open fracture is common
• Fracture Tibia is almost always associated with
Fibula
 Fracture Shaft Tibia and Fibula
• Clinical features
• Pain and swelling at fracture site
• Neurovascular injury is common
• Treatment
• Conservative is recommended
• If conservative treatment fails, ORIF is done by
means of Interlocking Nail or Plate
• Use of External fixator is common in this fracture,
esp if it is an open fracture
 Fracture Shaft Tibia and Fibula
• Complications
• Vascular injury
• Compartment syndrome
• Infection
• Malunion
• Delayed union
• Nonunion
• Joint stiffness
Fracture of Distal Tibia and Fibula
• Most important fracture at lower end of tibia
and fibula is called Pott’s fracture
• It is the fracture of both malleoli or fracture of
Medial Malleolus and shaft of Fibula
• Treatment
• Almost always surgical
• ORIF is indicated by means of Malleolar screw
for Medial Malleolus and plate or Rush-nail for
Fibula
 Fracture of Fibula alone
• It is non-weight bearing bone
• Usually no immobilization is needed
• Treatment:
• Analgesic and rest for few days
Asanteni sana