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INTRODUCTION
Fracture a break in the structural continuity of
bone, cartilage, joint and growth plate
If overlying skin remains intact : Closed
fractured
If skin not intact : Open Fractured
Nalyagam S. Principles of Fractures. In: Solomon L. Apleys System of Orthopaedics and Fractures Ninth edition. 2010
Anatomy
Largest
tubular
bone in the body
and is surrounded
by the largest
mass of muscle.
The
important
feature of femoral
shaft
is
its
anterior bow.
Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2010
Anatomy
ANTERIOR
COMPARTMENT
Quadriceps :
vastus lateralis,
vastus intermedius,
vastus medius,
rectus femoris
Anatomy
POSTERIOR
COMPARTMENT
contain three
large muscle
termed the
hamstring
Biceps Femoralis,
Semitendinous,
Semimembranou
s.
Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2010
Anatomy
MEDIAL COMPARTMENT
Gracilis
Adductor longus
Adductor brevis
Adductor magnus
Anatomy
The tibia is a long
tubular bone with a
triangular cross
section.
It has a
subcutaneous
anteromedial border
and is bounded by
four tight fascial
compartments
(anterior, lateral,
superficial posterior,
Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2010
Anatomy
The tibia is a long
tubular bone with a
triangular cross
section.
It has a
subcutaneous
anteromedial border
and is bounded by
four tight fascial
compartments
(anterior, lateral,
superficial posterior,
Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2010
Anatomy
ANTERIOR
COMPARTMENT
Tibialis anterior
Extensor hallucis
longus
Extensor
digitorum longus
Peroneus tertius
Anatomy
LATERAL COMPARTMENT
Peroneus longus
Peroneus brevis
Anatomy
SUPERFICIAL POSTERIOR
COMPARTMENT
M. Gastrocnemius
M. Soleus
M. Plantaris
Anatomy
DEEP POSTERIOR
COMPARTMENT
M. Posterior
tibialis
M. Flexor hallucis
longus
M. Flexor
digitorum longus
M. Popliteus
MECHANISM OF INJURY
Mechanism of
injury
Direct trauma
Indirect trauma
Energy of injury
High-energy
injuries
Low energy
injuries
Examples
Motor vehicle
accident
Torsional
(Fall and twisting)
Common Age
children and
adolescents
younger child
Classification
Femoral Shaft Fracture
Winquist and Hansen
Type 1
Type 2
Type 3
Type 4
CONFIGURATION CLASSIFICATION
OF SHAFT TIBIA
HOW TO DIAGNOSES ?
Chief complain,
Mechanism of
trauma, History
of prior
treatment
1. Look
2. Feel
3. Move
4. NVD
(Pain, Swelling,
Deformity)
views
joints
limbs
injuries
occasions
4
3
2
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P
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Xo
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Ria
1. Two
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tc
2. Two
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3. Two
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E
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5. Two
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m Solomon. L. et al. Apleys System of Orthopedics and Fractures 9 Edition. New York : Arnold. 2010
a
th
PATIENT EVALUATION
Closed fracture 1/3
middle left femur
Closed fracture 1/3
middle right fibula
Radiological
Examination
Physical
Transverse Fracture
Examination
1/3 middle left
History
Pain since 7
hours ago
- Feel down due
to traffic
accident
- History of prior
treatment
with casting
-
- Deformity
- Swelling
- Tenderness
femur
Transverse Fracture
1/3 middle right tibia
Solomon. L. et al. Apleys System of Orthopedics and Fractures 9th Edition. New York : Arnold. 2010
Reduction
Retain
Rehabilitation
Restore function
Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.
Treatment
CONSERVATIV
E
OPERATIVE
Indication :
- Fail Conservative
- Open fracture grade III (grossly
contaminate, associated vascular
injury)
- Fracture associated with
compartement
syndrome
- For traction (avulsion) fractures
Circular
in which fragment are held apart
Casting
- Fractures associated with
compartment syndrome
-Severely comminuted fractures
- Associated femoral fracture (floating
knee)
Internal Fixation
- Fractures in patients with spasticity
External Fixation
syndromes (cerebral palsy, head
injury)
fractures in which adequate
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of-unstable
Fractures, 4th Edition.
Indication :
- Closed fracture
- Open fracture grade
I-II
- Minimal Displaced
Treatment
Conservative
Operative
Analgetic
Debridement
Traction
External fixation
Close reduction +
cast immobilization
Intramedullary nailing
Plate and screws
Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.
Complication
Early
Compartement syndrome
Fat embolism .
Shock .
Infection .
Thromboembolism .
Late
Delayed union
Non-union .
Malunion .
Joint stiffness .
Refracture and implant failure .
Shortening of limb .
Solomon, L, Warwick D.L, Nayagam,S. Apleys system of orthopedic and fractures. 8th editions. 2008. p695-9