lower limb fractures

& Dislocations
Dr Guido Cabrera L
Traumatologa y Ortopedia
Ciruga Reconstructiva Extremidad Superior.
Servicio de Urgencia Clnica Las Condes

Topics

Ace tabular fractures.

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

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.

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

Pelvic Fractures
Pelvic fracture is a high energy trauma

as a result of MVA, 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 .

 Type B.

Rotationally Unstable ,Vertically

Stable.
B1. Open Book

B2 . Lateral Compression : Ipsilateral

lateral

B3. Lateral Compression :Contra

 Type C. Rotationally and Vertically Unstable

C1 . Unilateral
C2 . Bilateral
C3 . Associated with Acetabular
Fracture

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

Scan.

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.

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

complications
A.
B.
C.
D.
E.
F.

Hemorrhage life threatening

Bladder/bowel injuries
Neurological damage
Obstetrical difficulties
Persistent Sacro-iliac joint pain
Post traumatic arthritis of the hip with
acetabular fractures

Acetabular fracture
Usually it is a result of high- energy

trauma .
The acetabulum is divided into four
segmentsan 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 .

classification Letournel and

Judet

Investigation
AP pelvis.
Judat views ( Internal Oblique,Obturator
view)
C T scan .

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 BothColumn Fractures

 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 , PWP ,FWBAT.

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

More than 50% involvement of the

articular surface of the posterior wall or
clinical instability with hip flexion to 90
degrees in posterior wall fractures .
Incarcerated Fragments in the Acetabulum
after Closed Reduction of a Hip
Dislocation.

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

HIP Dislocations

Complication
post traumatic arthritis
Femoral head injury with risk of AVN

(100% if
the
dislocation last >12 H)
Sciatic nerve palsy 25% ( 10 %
permanent)
Femoral shaft /neck fracture
knee injury

Treatment
neck of femur
Nondisplaced fracture of neck of femur
can be treat with canulated screws.
Displaced fracture ----------DHS in patient
less than 60 years.
> than 65 years look for.
. Level of activities.
. Status of the acetabulum.
then chose THR vs hemi arthoplasty.

Treatment
Intertrochantaric fracture-------DHS . DCP.
Subtrochantaric fracture---------

DHS.ABP.DCP.
Combination of both------- IM Nail with
Canulated srews.