Injuries around leg Dr Abhishek Pathak Asst. Prof Deptt of Orthopaedics & traumatology Gandhi Medical college Bhopal
Bones
TIBIAL PLATEAU
DIAPHYSIS
PLAFOND/ PILON
Tibial plateau fracture Caused by high-energy mechanisms associated with neurological and vascular
injury, compartment syndrome caused by motor vehicle accidents or bumper strike injuries KNOWN AS BUMPERS FRACTURE. Classified by SHATZEKAR CLASSIFICATION
SHATZEKAR CLASSIFICATION
BUTRESS PLATING
HYBRID FIXATURE
TIBIAL SHAFT FACTURE Tibia major weight bearing bone Fibula transmits only 10% of body weight Both bones are joined together by
1. Ligaments at upper and lower ends 2. Interosseous membrane Mostly both bones fractures together
Very common injury High speed RTA PECULIARTIES 4. Subcutaneous bone 5. Lack of muscle cover 6. Precarious blood supply b/c of decreased periosteal blood supply
Mode of injury 1.
Direct
2. Indiect
most common
twisting injury
spiral or oblique #
Most of the tibial shaft fractures are open
Difficult to manage 5. Increased morbidity 4.
Diagnosis 1. 2. 3. 4. 5. 6.
History Pain Swelling Deformity Wound :- if compound # Crepitus.
What to do?? In all trauma cases first look for 2. A 3. B 4. C
What to do?? In all trauma cases first look for
A • B • C •
AIRWAY BREATHING CIRCULATION
LOOK FOR OTHER INJURIES ALWAYS CHECK DISTAL PULSES, MONITER VITALS RADILOGICAL EXAMINTION AFTER PATIENT STABLIZATION
TREATNENT PAIN CONTROL
Splinting by A/K Plaster Slab Analgesic SOS Skeletal traction in tibial plateau fracture
Patient complaining of excessive pain after # BB leg Open slab immediately Watch for tense compartment of leg
COMPARTMENT SYNDROME
Compartment syndrome as an elevation of
the interstitial pressure in a closed osseofascial compartment that results in microvascular compromise
COMPARTMENT SYNDROME 2. 3. 4. 5. 6.
FIVE Ps Pain: pain out of proportion to that expected with the injury Pallor Pulselessness Paresthesias Paralysis.
If compartmental pressures are greater than
30 mm Hg in the presence of clinical findings, immediate fasciotomy is indicated. Difference between compartment pressure
and diastolic pressure more imp indicator of tissue perfusion.
Not all signs need to be present Only clinical basis is enough is sufficient to do
a fasciotomy All compartment of leg should be released
Treatment.
Treatment Conservative Operative
Conservative treatment closed # Undisplaced or minimally displaced In children Poor surgical risk
Method Above knee cast PTB cast
Cast bracing sarmiento
operative Method of coice Early mobilisation
Many methods
Interlocking nails
ORIF with DCP
Locking compression Plates
External fixature Mainly for open fracture
Complications Nonunion Malunion Infection Massive pulmonary embolism ARDS Fat embolism
Phemister grafting Used for treatment of nonunion of tibial shaft
fracture
Tibial plafond fracture Lower end tibial fracture Associated with soft tissue injury.
MESS Mangled extremity severity score
Type Characteristics Injuries Points SKELETAL/SOFT TISSUE GROUP 1. Low energy Stab wounds, simple closed fractures, small-caliber gunshot wound 2. Medium energy Open or multiple-level fractures, dislocations, moderate crush injuries 3. High energy Shotgun blast (close range), high-velocity gunshot wounds 4. Massive crush Logging, railroad, oil rig accidents
SHOCK GROUP 1 Normotensive hemodynamics 2 Transiently hypotensive 3Prolonged hypotension
Blood pressure stable in field and in operating room BP unstable in field but responsive to intravenous fluids Systolic blood pressure less than 90 mm Hg in field and responsive to intravenous fluid only in operating room
1 2 3 4
0 1 2
ISCHEMIA GROUP 1 None A pulsatile limb without signs of ischemia
0†
2Mild
Diminished pulses without signs of ischemia
1†
3Moderate
No pulse by Doppler, sluggish capillary refill paresthesia, diminished motor activity
2†
4Advance
Pulseless, cool, paralyzed and numb without capillary refill
3†
AGE GROUP 1<30 years 2 >30 <50 years 3 >50 yrs
0 1 2
limbs with scores of 7 to 12 ultimately
required amputation, whereas scores of 3 to 6 resulted in viable limbs.