1. surgry

2. Pelvic fractures

3. Emergency treatment Stop bleeding otherwise Stabilize pelvis
Surgical tamponade laparotomy (dcs)
retroperitoneum
Embolization

4. A hemodynamically unstable patient
Exclude other sources
Open wound
Hemothorax
Hemoabdomen
Long-shaft bone fractures

5. Operative treatment options
External fixation
Internal fixation
screws
plates
Combinations

6. Femoral fractures

7. Femoral fractures Proximal femoral fractures
neck fracture –
intracapsular,
extraarticular
31-B
head fracture-
intracapsular,
intraarticular
31-C
trochanteric area-
extracapsular
31-A
Classification

8. Proximal Femoral Fractures

9. medial circumflex artery
lateral circumflex artery
Blood supply

10. Incidence Elderly Young Low energy Osteoporosis Female High energy

11. Indication for fixation
Impacted and undisplaced fracture: cannulated screws—implant of choice
minimal exposure
parallel to allow
compression

12. Treatment algorithm displaced under 55 55-85 over 85
no significant co-morbidity
displaced
under over 85

13. Internal fixation
Multiple cannulated screws
Dynamic hip screw

14. Internal fixation—complications
30% fixation failure/loss of reduction
Avascular necrosis
Nonunion

15. Arthroplasty—options

16. Arthroplasty—complications
Dislocation
Infection
Acetabular erosion
Leg length inequality

17. Nailing of subtrochanteric fractures The solid femoral nail1 2 3 1 2 3

18. Long PFN

19. Indirect reduction—use of external fixator

20. Distal Femoral Fractures

21. Epidemiology 6% of all femur fractures Younger/High Energy
50% (intraarticular) open
1/3 Polytrauma
1/5 Isolated
Older/Osteoporotic

22. Position for surgery

24. TibiFractures

25. Soft-tissue injury
Complications and prognosis are directly related to the degree of soft-tissue injury

26. Nonoperative treatment
Children
Undisplaced fractures
“Stable” reduced fractures
Contraindication for surgery:
- patient
- health care team

27. Tibial fixation options
Plate
Ex Fix
IMN

29. Compression plating—poor technique