1. FRACTURES
0F LOWER LIMB BY
Vishnu Mohan

2. Topics Mechanism of fractures fracture of femur fracture of patella
Tibial and fibular Fractures.
Ankle fractures
fracture of foot
Fracture of pelvis.

3. fractures
A bone fracture is a medical condition in which there is a break in the continuity of the bone

4. Types
Closed{simple} open{compound} Compression Complete Incomplete Linear Transverse Oblique Spiral Impacted comminuted

9. Mechanism of fractures
Lower limb fracture is a result of a high energy trauma except in elderly people or diseased bones
Types of fracture are depend on position of limb during impaction and magnitude of forces applied.

10. femur
Upper end
shaft
Lower end

11. Fractures of head of femur
The head and neck of the femur is primarily intended for transmission of body weight efficiently with minimum bone mass.

12. - Mechanism : - Minimal trauma in old people with osteoporosis
- High energy trauma in young adults .

13. Intracapsular Extracapsular
Types
Intracapsular Extracapsular

14. Intracapsular types subcapital- just distal to femoral head Transcervical– at the middle of femoral neck

15. Extracapsular types
Intertrochanteric- passes between two trochanters pertrochanteric –passes through the two trochanters,one or both of which may be seperated
Subtrochanteric -2or3 inches below lesser trochanter

17. incomplete fracture of the neck (so called abducted or impacted)

18. complete without displacement

19. this is a complete femoral neck fracture with full
displacement: the proximal fragment is free and lies
correctly in the acetabulum so that the trabeculae
appear normally aligned

20. - Immobilization with traction until surgery
- Management :
- Immobilization with traction until surgery
- Surgery: indicated to stabilize the fracture to help healing,
- Internal fixation by, angled plate , condylar plate or
multiple pins .
- Arthroplasty

21. Surgical reconstruction or replacement of degenerated joint
Arthroplasty
Surgical reconstruction or replacement of degenerated joint

22. Examples of Internal Fixation

23. Fracture of Femoral Shaft :
- Mechanism :
- High energy trauma , falling from height
- Management :
- Closed reduction ( In children )
- Open reduction internal fixation by plate and screws
or interlocking nail .( In adult)
- External fixator .

24. Open reduction of a fracture involves making an incision in the skin and putting the fractured bones together and stabilizing with screws or plates or rods. Closed reduction means just that: no incision made, the fracture is manipulated under a type of X-ray machine called fluoroscopy or just by feel and a cast is then usually applied. Open usually leads to quicker healing because the fragments are held together. Closed has the advantage of avoiding an operation but the healing can be slower because the bones are not rigidly held together.

25. External fixator

27. splint 
 a rigid or flexible appliance for fixation of displaced or movable parts
Thomas splint
A long leg splint that extends from a ring at the hip to beyond the foot, allowing traction to a fractured leg, and is used in emergencies and for transportation.

28. (B), Thomas knee splint.

29. PATELLAR FRACTURES

30. circular-triangular bone
The patella, also known as the knee cap or kneepan
 circular-triangular bone
 It is the largest sesamoid bone in the human body.

31. PATELLAR FRACTURES Caused by direct injury or by indirect injury
The type of fracture is different in both
Treatment is also different

32. 1.direct [stellate] 2.indirect [transverse]
Types
1.direct [stellate]
2.indirect [transverse]

33. Direct Mechanism- a fall on patella,
heavy object falling across the knee
Inspection- knee joint is extremely swollen,
in slightly flexed position
Palpation- effusion in the knee joint is easily
determined

34. X ray- shows fracture lines running radialy
X ray- shows fracture lines running radialy. There may or may not be any displacement
full extension of the knee joint is possible in majority of cases.

35. Treatment 1.When there is crack fracture with no displacement
operation is not needed
2. Even slight displacement patellectomy is the treatment of choice, irregular articular surface of patella will damage the femoral articular cartilage and lead to osteoarthritis early in age

36. pattellectomy
An operation to remove the patella.

37. Indirect Mechanism- when a person slips on leg with the
other leg in a semi flexed position
Inspection- there is swelling but is less than direct
fracture
Palpation- one can feel the fracture line and even gap between the segments
the patient is unable extend the knee and is also unable to lift the leg

38. Treatment 1.Undisplaced crack fracture by plaster cylinder
2.With separation{in middle}
a) internal fixation
b) patellectomy

40. Fracture Tibia & Fibula :
- Mechanism :
- Direct trauma , falling .
- Management :
- Closed reduction & cast immobilization .
- Open reduction internal fixation by plate
and screws or inter locking nail .

43. Tibial and fibular fractures

44. Fractures of the Ankle

45. Fractures of the Ankle Classification : Management :
- According to mechanism of injury : - Abduction
- Adduction
- Ext. rotation
- Vertical compression
Management :
Surgical treatment is indicated to restore normal
anatomy and function of ankle joint

47. Examples of Internal Fixation

48. Fractures of foot

50. Fractures of calcaneum
Mechanism - fall from height degree of displacement also varies according to the violence Types Chip fractures- rare type Split fractures- split in to two fragments Crush fractures- the portion which articulates with talus is completely crushed

51. Functional treatment
a crepe bandage is applied, the foot is elevated and active exercises are encouraged from the beginning. Majority of patients return to full activity within 6 months.

52. Fractures of metatarsal bones

53. Mechanism – from direct violence usually at the neck Treatment - mainly functional method Stress fracture{march fracture} – due to long march or overuse mostly in 2nd metatarsal

54. Pelvis Fractures

55. Pelvis – three bones make up each side of the pelvis
Pelvis – three bones make up each side of the pelvis. (ilium, ishium,and pubis) They are connected to the sacrum by ligaments.

56. Causes…
Elderly people with osteoporosis. May fracture pelvis during a fall. These injuries do not usually damage the structural integrity of the pelvic ring, but may fracture an individual bone.

57. Causes…
High- energy forces – what most fractures involve Crush accident
Falls
Surgical treatment may need to be done, depending on the direction and degree of the forces
Injuries can possibly be life-threatening

58. Blood vessels and nerves
Diagnosis…
X-Rays
CT scans
Blood vessels and nerves

59. Treatment…. Nonsurgical Stable fracture Use of crutches or walker
Partial weight bearing up to 3 months

60. Treatments… Surgical Unstable fractures External fixator Traction
Plates and screws

61. Outcomes…. Stable vs. non-stable Gait Subsequent Problems pain
Impaired mobility
Sexual dysfunction

62. Thank you