Fractures of the Leg and Management Walter Grady, D.O. Discipline Chair of Orthopedics and Acting Discipline of Surgery

Fractures of the Hip post menopausal female is14% men 6% 6.26 million by 2050

Fractures of the Hip 51% fractures in women and 24% in men……osteoporosis 50% lose ability to walk 25% require care thereafter Mortality6mos30 %

Fractures of the Hip Blood Supply Core Principle: Medial Circumflex Artery Supplies Most of Blood to Head & Neck of Femur

Delbet Classification of Hip Fractures in Children AVN incidence is higher in type I & II injuries than in type III & IV *Type IA, IB, II,III,IV Type IV Pediatric Hip Fracture Treated with Hip Spica Cast

Osteonecrosis Hip Types

Surgical Treatment for Osteonecrosis Pediatric Hip *Free Vascularized Fibular Grafting for Treatment of Post Collapse Osteonecrosis Fem. Head.

SCFE 11/100,000 Boys > Girls Black > White 60% over 95th percentile weight 18% to 63 % Bilateral 82% 2nd case occur 18 months

SCFE Main Blood Supply Screw Placement Lateral Epiphyseal Vessels (branch of medial femoral circumflex) Enter Posterosuperiorly and anastomose with vessels from vessels from ligamentum teres Screw Placement Avoid posterior superior quadrant to avoid lateral Epiphyseal vessels. Ideal position is central.

SCFE Clinical Evaluation Externally rotated & Thigh Atrophy Loss of Internal rotation Unstable Slip – Pt. holds hip flexed & ER Whitman’s Sign = Hip Flexion past 90 deg Causes hip to ER

Adult Hip Fracture Classification

Fractures of the Femur Adults Annual Incidence Femoral Shaft Fractures 10/100,000 Peaks young….decreases after age 20 Increases…..after 75 Majority Proximal Third Older Adults – Low Energy falls most common cause…..65% Femur Fractures

Salter Harris Pediatric Fracture Classification

Femur Fractures in Children Epidemiology < 1 yr. age….Most Common Cause Femur Fracture is Child Abuse……70% 1-4 yr. age….Child Abuse is the leading cause of Femur Fracture Adolescents…..MVA responsible….90%

Femur Fractures in Children Treatment < 6 mos  Pavlik Harness 7 mos – 5yrs  Hip Spica Cast should not overlap > 2cm > 3cm shortening or malaligned in the Spica Cast  Attempt Traction > 3cm shortening Surgical Indication Age 6 – 10 Flexible Intramedullary Nails & Early ROM

Femur Fractures Children Treatment Closed Treatment – Traction Closed Treatment – Hip Spica Cast Closed Treatment – Flexible Nails Open Treatment – Only if the best option

Femur Fractures in Children Rigid Locked IM Nail: Used in adolescents who are nearly grown and if Fracture is Unstable External Fixation: Used to Stabilize Bones in Presence of Significant soft tissue injury

Tibia Fractures The most commonly fractured long bone 2/1000 Avg. age  37 Teenage males Core Principle

Fracture of the Tibia Student Doctor Case

Gustillo Classification Open Fractures Core Principle