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Fracture Lower Extremity Part II

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Fracture Lower Extremity Part II CONTENTS FEMUR SHAFT BOTH BONE SUBTROCHANTERIC TIBIAL PLAFON FRACTURE LOWER FRACTURE ANKLE EXTREMITIES: PART 2 FRACTURE FEMUR FOOT SUPRACONDYLAR FRACTURE FEMUR CALCANEUS PATELLA TALUS WORAWAT LIMTHONGKUL, M.D. 14 JAN 2013 TIBIA LISFRANC’S TIBIAL PLATEAU METATARSAL 1 2 SUBTROCHANTERIC FRACTURE FEMUR A PART OF FRACTURE OCCUR BETWEEN TIP OF LESSER TROCHANTER AND A POINT 5 SUBTROCHANTERIC CM DISTALLY CALCAR FEMORALE FRACTURE LARGE FORCES ARE NEEDED TO CAUSE FRACTURES IN 5 CM YOUNG & ADULT INJURY IS RELATIVELY TRIVIAL IN ELDERLY 2° CAUSE: OSTEOPOROSIS, OSTEOMALACIA, PAGET’S 3 4 SUBTROCHANTERIC FRACTURE FEMUR TREATMENT INITIAL FEMUR SHAFT TRACTION DEFINITE FRACTURE ORIF WITH INTRAMEDULLARY NAIL OR 95 DEGREE HIP- SCREW-PLATE 5 6 FEMUR FRACTURE FILM HIPS SEVERE PAIN, UNABLE TO BEAR WEIGHT 10% ASSOCIATE FEMORAL SUPRACONDYLAR NECK FRACTURE FEMUR FRACTURE TREATMENT: ORIF WITH IM NAIL OR P&S COMPLICATION: HEMORRHAGE, NEUROVASCULAR INJURY, FAT EMBOLI 7 8 SUPRACONDYLAR FEMUR FRACTURE SUPRACONDYLAR ZONE DIRECT VIOLENCE IS THE USUAL CAUSE PATELLA FRACTURE LOOK FOR INTRA- ARTICULAR INVOLVEMENT CHECK TIBIAL PULSE TREATMENT: ORIF WITH P&S 9 10 PATELLA FRACTURE PATELLA FRACTURE FUNCTION: LENGTHENING THE ANTERIOR LEVER ARM DDX: BIPATITE PATELLA AND INCREASING THE (SUPEROLATERAL) EFFICIENCY OF THE QUADRICEPS. TREATMENT: DIRECT VS INDIRECT NON-DISPLACE, INJURY INTACT EXTENSOR : CYLINDRICAL CAST TEST EXTENSOR MECHANISM DISPLACE, DISRUPT EXTENSOR: ORIF WITH VERTICAL FRACTURE: TBW MERCHANT VIEW 11 12 PATELLAR DISLOCATION ADOLESCENT FEMALE DISLOCATION AROUND USUALLY DISLOCATED LATERALLY KNEE JOINT TREATMENT: REDUCE BY EXTENSION AND MANUAL MEDIAL DISPLACEMENT CAST 2-3 WEEKS 13 14 KNEE DISLOCATION OFTEN REDUCE SPONTANEOUSLY ASSOCIATED WITH TIBIAL PLATEAU INJURY TO POPLITEAL ARTERY: OBTAIN ABI’S FRACTURE (+) ! ARTERIOGRAM PERONEAL NERVE INJURY > TIBIAL NERVE MONITOR SIGN OF VASCULAR INJURY 15 16 TIBIAL PLATEAU FRACTURE HIGH ENERGY TRAUMA: FRACTURE MEDIAL TIBIAL PLATEAU TIBIA AND FIBULAR ASSOCIATED NEURO- VASCULAR INJURY FRACTURE BE AWARE FOR COMPARTMENT SYNDROME TREATMENT: DISPLACE > 5MM :ORIF SCHATZKER CLASSIFICATION 17 18 FRACTURE BOTH BONE OPEN FRACTURE LEG AWARE FOR OPEN FRACTURE OBSERVE COMPARTMENT SYNDROME TREATMENT: LONG LEG CAST OR ORIF INDICATIONS FOR SURGERY FAILED CLOSED TREATMENT MULTIPLE INJURIES SEGMENTAL FRACTURE MALUNION NONUNION PATHOLOGICAL FRACTURE ISOLATED TIBIAL FRACTURE 19 20 COMPARTMENT SYNDROME CRUSH INJURY FRACTURE: TIBIA (MOST COMMON: ANTERIOR TIBIA COMPARTMENT), FOREARM TIBIAL PILON 5 “P”S; PAIN (EARLIEST SYMPTOM), PALLOR, PARESTHESIA, PARALYSIS, PULSELESSNESS FRACTURE INDICATION FOR SURGERY: >40 MMHG OR DIASTOLIC PRESSURE - COMPARTMENT PRESSURE <30 MMHG IRREVERSIBLE DAMAGE >6 HOURS WHITESIDE TECHNIQUE TREATMENT: FASCIOTOMY 21 22 TIBIAL PILON FRACTURE TIBIAL PILON (DISTAL) = PLAFOND (CEILING) ANKLE FRACTURE MECHANISM: AXIAL LOAD TREATMENT: ORIF 23 24 ANKLE FRACTURE MAISONNEUVE FRACTURE WEBER CLASSIFICATION 1972 EXTERNAL ROTATION OF THE TYPE A : FRACTURE BELOW THE LEVEL OF ANKLE CAUSING THE DISTAL TIBIAL FIBULAR SYNDESMOSIS RUPTURE OF MEDIAL TYPE B : FRACTURE AT THE LEVEL OF LIGAMENT COMPLEX SYNDESMOSIS (DELTOID LIGAMENT) TYPE C : FRACTURE ABOVE THE JOINT LINE ASSOCIATED PROXIMAL TREATMENT FIBULAR FRACTURE A : NONOPERATIVE TREATMENT = SHORT LEG CAST 6-12 WEEKS MAY REQUIRE SURGERY B : +/_ SURGERY MISSED ON ANKLE X-RAY C : SURGERY = ORIF 25 26 CALCANEAL FRACTURE MECHANISM: COMPRESSION FROM FALL ASSOCIATED WITH FOOT FRACTURE THORACOLUMBAR FRACTURE KNEE OR HIP FRACTURE GU, RENAL INJURY X-RAY: LATERAL AND AXIAL (HARRIS) VIEW BOEHLER’S ANGLE: NORMAL 25°-40° 27 28 TALUS FRACTURE LISFRANC’S FRACTURE MECHANISM: ANKLE HYPEREXTENSION LISFRANC JOINT = TARSO- METATARSAL JOINT TALUS NECK METATARSAL BASE FRACTURE TREATMENT: METATARSAL DISLOCATION UNDISPLACED: SHORT LEG SLAP WITH ANKLE 2ND METATARSAL BASE IS CRITICAL PLANTAR-FLEXION 8-12 FOR STABILITY OF MIDFOOT WEEKS MAY REQUIRE ORIF DISPLACE: ORIF 29 30 STRESS INJURY FIFTH METATARSAL FRACTURE (MARCH TOE) DANCER’S AVULSION FRACTURE BASE OF 5TH MT ATTACHMENT OF PERONEUS BREVIS OFTEN A MILITARY INVERSION INJURY RECRUIT OR A NURSE CAST SHOE USUALLY THE SECOND JONES’ METATARSAL IS AFFECTED TRANSVERSE FRACTURE PROXIMAL DIAPHYSIS ELASTIC BANDAGE COMMON IN ATHLETES (RUNNING OR JUMPING SPORTS) NO SPLINT NEEDED INCREASE INCIDENCE OF NONUNION ORIF OR CAST 31 32 THANK YOU 33.
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