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

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

3. 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 %

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

5. 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

6. Osteonecrosis Hip Types

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

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

9. 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.

10. 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

11. Adult Hip Fracture Classification

12. 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

13. Salter Harris Pediatric Fracture Classification

14. 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%

15. 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

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

17. 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

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

19. Fracture of the Tibia
Student Doctor Case

20. Gustillo Classification Open Fractures
Core Principle