Injuries Around Leg

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.