H. Sithebe 1 Orthopaedics Department

FEMUR FRACTURES Femur Head Femur Neck Intertrochanteric Subtrochanteric Shaft Supracondylar Condylar 2

FEMUR NECK FRACTURES CAUSES CLINICAL PRESENTATION CLASSIFICATION MANAGEMENT 3

FEMUR NECK FRACTURES Common-Elderly patients, Caucasians, women, Ass medical conditions CLASSIFICATION-Garden- Dis /Undisplaced -Intra/ extra capsular 4

GARDEN CLASSIFICATION 5

FEMUR NECK FRACTURES Displaced – young patient- ORIF -Older patient- Arthroplasty Undisplaced- ORIF Complications - AVN - young Cx Elderly-Confusion, Electrolyte imbalances, UTI,Pneumonia, pressure sore etc Q-within 4 days 6

FEMUR INTERTROCAHNTERIC #”S 7

Risk Factors-  Osteoporosis, medical co morbidities, positive maternal history Classification –  Stable / Unstable  Stable- 2 part, sustains medial compressive forces  Unstable- 3 part, Falls into Varus, cannot sustain -Reverse oblique 8

FEMUR INTERTROCAHNTERIC #”S MANAGEMENT  Resuscitate patient  Consult Physicians and Anaesthetist  Planned surgery within 4 days  DHS, Cephalo medullary Device- choose according to # pattern 9

FEMUR INTERTROCAHNTERIC #”S Early-mentioned before Late -Implant failure, Infection, -Mortality, Leg length discrepancy 10

SUBTROCHANTERIC FRACTURES Causes- High E transfer –Young Pts Anatomically- 5cm below the lesser trochanter Forces acting- PICTURE 11

SUBTROCHANTERIC FRACTURES MANAGEMENT-ABC ORIF Complications- Non Union –Watershed area -Mal Union & same 12

FEMUR SHAFT  CAUSES-High E Trauma  CLINICAL PRESENTATION -Isolated/ Poly Trauma Leg shortened external rotation Pain etc  CLASSIFICATION-Pattern of Fracture 13

FEMUR SHAFT MANAGEMENT  ABC  Prevent possible complications eg Fat embolism Sx  Exclude ass #”s-3% neck #- 30% missed  Exclude ass Knee Injuries- 10% LIGAMENT Injuries  IM Nail= ORIF 14

FEMUR DISTAL CAUSES-Same CLINICAL PRESENTATION-Swelling, Pain etc -NB! –Vascular injury CLASSIFICATION  Supracondylar (Extra-articular )  Intercondylar(Intra-articular ) 15

FEMUR DISTAL MANAGEMENT  ABC  Exlude Popliteal Art Injury  ORIF  Early Knee ROM 16

PATELLA FRACTURES CAUSES- Direct or avulsion CLINICAL PRESENTATION  Same all trauma  Specific- Inability to extend the Knee  Evaluate the Iliotibial tract and Patella Retinaculum  Old- tendon intra substance tear  Young-Avulsion injuries 17

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PATELLA FRACTURES CLASSIFICATION  Transverse  Vertical  Comminuted MANAGEMENT  Displaced -2mm step, 3mm apart-ORIF  Undisplaced-Ranger Brace 6 weeks 19

TIBIA FRACTURES PROXIMAL CAUSES- High E Transfer -Axial loading with either Varus - or Valgus stress CLINICAL PRESENTATION  -Same Trauma  -Specific evaluate Vascular Injury  - ass ligament injuries 20

TIBIA FRACTURES PROXIMAL CLASSIFICATION- Schatzker Classification 21

TIBIA FRACTURES PROXIMAL MANAGEMENT  ABC  Evaluate axial skeleton  Stabilise  Definitive-ORIF 22

QUESTIONS THANK YOU 23