Fracture Of Lower Extremity Fracture Of Lower Extremity

Fracture of lower extremity Baoheng

Femoral neck fracture

Blood Supply to Femoral Head & Neck

Garden Classification • Garden I: - incomplete or impacted fracture, in which the trabeculae of the inferior neck are still intact • Garden II: - complete frx w/o displacement • Garden III: complete fracture with partial displacement • Garden IV :complete fracture w/ total displacement

Garden Classification

subcapital

transcervical basal

• Adduction • Abduction

Pauwells angle

Diagnosis • Inability to bear weight after a fall, with or without pain in the hip • External rotation of the limb with a little shortening • Tenderness over the femoral neck anteriorly • X ray: AP and lateral view

Treatment • Reduction and internal fixation: for young , middle aged , elderly fit patients • Arthroplasty: elderly patients with high risks of avascular necrosis and non-union • Conservative measures

• 8 years after fracture

Necrosis of femoral head

Intertrochanteric Fractures • Type I: non displaced • Type II:minimally comminuted, but displaced • Type III: has a large posteromedial comminuted area • Type-IV:including the comminuted fractures of the lesser and larger trochanters • Type V: Reversed Obliquity

Treatment • Conservative measure: traction for stable fracture,frx usually stabilizes w/ in 8 wks & allows wt bearing in 12 weeks • Surgery: unstable fracture

Femoral Shaft Fracture • Proximal 1/3 • Middle 1/3 • Distal 1/3

Treatment • Conservative measures: traction for child (less than 3 years old), stable fracture of adult • Surgery

Indications for surgery • Failure of conservative measures • Multiple fractures in the same limb • With blood vessels and nerve injury • Elderly patient • Un-union • Mild contamiated open fracture

Patellar fracture • Upper polar • Lower polar • Comminuted

Treatment • Conservative measures • Surgery

Fracture of tibial plateau •

Schatzker classification

• Type I : split fractures of the lateral tibial plateau, • Type II: split fractures with depression of the lateral articular surface • Type III: fractures are characterized by depression of the lateral tibial plateau, • Type IV :fractures involve the medial tibial plateau and may be split fractures with or without depression. • Type V fractures are characterized by split fractures through both the medial and lateral tibial plateaus. • Type VI fractures are the result of severe stress and result in dissociation of the tibial plateau region from the underlying diaphysis

Treatment • Conservative measures for the fractures without displacement • Surgery

Fracture of the tibia and fibula

Both fracture of the tibia and fibular Tibial fracture Fibular fracture

Treatment • Conservative measures • Surgery

Indications for surgery • Failure of the conservative measures • Serious comminuted fracture • Mild contaminated open fracture

Ankle fracture

The Danis-Weber classification • Type A: fracture below the ankle joint Type B: fracture at the level of the joint, with the tibiofibular ligaments usually intact Type C: fracture above the joint level which tears the syndesmotic ligaments

Treatment

Non Operative Treatment for indicated for stable Weber B frx Surgery

Fracture of the calcaneum • Extraarticular Fracture (without influencing the sub-talar joint) • Intraarticular Fracture (influencing the sub-talar joint) •

Bohler angle