FRACTURES 0F LOWER LIMB

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FRACTURES 0F LOWER LIMB

  1. 1. FRACTURES<br /> 0F LOWER LIMB <br />BY<br />Vishnu Mohan<br />
  2. 2. Topics<br /><ul><li>Mechanism of fractures
  3. 3. fracture of femur
  4. 4. fracture of patella
  5. 5. Tibial and fibular Fractures.
  6. 6. Ankle fractures
  7. 7. fracture of foot
  8. 8. Fracture of pelvis.</li></li></ul><li>fractures<br />A bone fracture is a medical condition in which there is a break in the continuity of the bone <br />
  9. 9. Types<br /> Closed{simple}<br /> open{compound}<br /> Compression<br /> Complete<br /> Incomplete<br /> Linear<br /> Transverse<br /> Oblique<br /> Spiral<br /> Impacted<br /> comminuted<br />
  10. 10.
  11. 11.
  12. 12.
  13. 13.
  14. 14. Mechanism of fractures<br />Lower limb fracture is a result of a high energy trauma except in elderly people or diseased bones <br />Types of fracture are depend on position of limb during impaction and magnitude of forces applied.<br />
  15. 15. femur<br /><ul><li>Upper end
  16. 16. shaft
  17. 17. Lower end</li></li></ul><li>Fractures of head of femur<br />The head and neck of the femur is primarily intended for transmission of body weight efficiently with minimum bone mass. <br />
  18. 18. - Mechanism :<br /> - Minimal trauma in old people with osteoporosis<br />- High energy trauma in young adults .<br />
  19. 19. Types<br />Intracapsular<br />Extracapsular <br />
  20. 20. Intracapsular types<br />subcapital- just distal to femoral head <br />Transcervical– at the middle of femoral neck <br />
  21. 21. Extracapsular types<br />Intertrochanteric- passes between two trochanterspertrochanteric –passes through the two trochanters,one or both of which may be seperated<br />Subtrochanteric -2or3 inches below lesser trochanter<br />
  22. 22.
  23. 23. incomplete fracture of the neck<br />(so called abducted or impacted)<br />
  24. 24. complete without displacement<br />
  25. 25. this is a complete femoral neck fracture with full<br />displacement: the proximal fragment is free and lies<br />correctly in the acetabulum so that the trabeculae <br />appear normally aligned<br />
  26. 26. - Management :<br />- Immobilization with traction until surgery<br /> - Surgery: indicated to stabilize the fracture to help healing,<br /> - Internal fixation by, angled plate , condylar plate or<br /> multiple pins .<br /> - Arthroplasty <br />
  27. 27. Arthroplasty<br />Surgical reconstruction or replacement of degenerated joint<br />
  28. 28. Examples of Internal Fixation<br />
  29. 29. Fracture of Femoral Shaft :<br />- Mechanism :<br />- High energy trauma , falling from height<br /> - Management :<br /> - Closed reduction ( In children )<br /> - Open reduction internal fixation by plate and screws<br /> or interlocking nail .( In adult)<br /> - External fixator .<br />
  30. 30. 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.<br />
  31. 31. External fixator<br />
  32. 32.
  33. 33. splint <br /> a rigid or flexible appliance for fixation of displaced or movable parts<br />Thomas splint<br />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.<br />
  34. 34. (B), Thomas knee splint.<br />
  35. 35. PATELLAR FRACTURES<br />
  36. 36. The patella, also known as the knee cap or kneepan<br /> circular-triangular bone<br /> It is the largest sesamoid bone in the human body.<br />
  37. 37. PATELLAR FRACTURES<br /> Caused by direct injury or by indirect injury<br /> The type of fracture is different in both <br /> Treatment is also different <br />
  38. 38. Types<br /> 1.direct [stellate] <br /> 2.indirect [transverse]<br />
  39. 39. Direct <br />Mechanism- a fall on patella, <br />heavy object falling across the knee <br />Inspection- knee joint is extremely swollen, <br />in slightly flexed position <br />Palpation- effusion in the knee joint is easily <br /> determined <br />
  40. 40. X ray- shows fracture lines running radialy. There may or may not be any displacement <br /> full extension of the knee joint is possible in majority of cases. <br />
  41. 41. Treatment <br />1.When there is crack fracture with no displacement <br /> operation is not needed <br />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 <br />
  42. 42. pattellectomy<br /> An operation to remove the patella. <br />
  43. 43. Indirect <br />Mechanism- when a person slips on leg with the <br /> other leg in a semi flexed position<br />Inspection- there is swelling but is less than direct<br /> fracture <br />Palpation- one can feel the fracture line and even gap between the segments <br /> the patient is unable extend the knee and is also unable to lift the leg <br />
  44. 44. Treatment <br />1.Undisplaced crack fracture by plaster cylinder <br />2.With separation{in middle}<br /> a) internal fixation <br /> b) patellectomy <br />
  45. 45.
  46. 46. Fracture Tibia & Fibula:<br />- Mechanism :<br />-Direct trauma , falling .<br /> - Management :<br /> - Closed reduction & cast immobilization .<br /> - Open reduction internal fixation by plate<br /> and screws or inter locking nail .<br />
  47. 47.
  48. 48.
  49. 49. Tibial and fibular fractures<br />
  50. 50. Fractures of the Ankle<br />
  51. 51. Fractures of the Ankle<br />Classification :<br /> - According to mechanism of injury : - Abduction<br /> - Adduction<br /> - Ext. rotation<br /> - Vertical compression<br />Management :<br />Surgical treatment is indicated to restore normal<br /> anatomy and function of ankle joint <br />
  52. 52.
  53. 53. Examples of Internal Fixation<br />
  54. 54. Fractures of foot<br />
  55. 55.
  56. 56. Fractures of calcaneum <br />Mechanism - fall from height <br />degree of displacement also varies according to the violence <br />Types<br />Chip fractures- rare type<br />Split fractures- split in to two fragments<br />Crush fractures- the portion which articulates with talus is completely crushed<br />
  57. 57. Functional treatment<br /> 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. <br />
  58. 58. Fractures of metatarsal bones<br />
  59. 59. Mechanism – from direct violence <br />usually at the neck <br /> Treatment - mainly functional method <br />Stress fracture{march fracture} – <br />due tolong march or overuse<br /> mostly in 2nd metatarsal<br />
  60. 60. Pelvis Fractures<br />
  61. 61. Pelvis – three bones make up each side of the pelvis. (ilium, ishium,and pubis). They are connected to the sacrum by ligaments. <br />
  62. 62. Causes…<br />Elderly people with osteoporosis.<br />May fracture pelvis during a fall. <br />These injuries do not usually damage the structural integrity of the pelvic ring, but may fracture an individual bone.<br />
  63. 63. Causes…<br />High- energy forces – what most fractures involve Crush accident <br />Falls <br />Surgical treatment may need to be done, depending on the direction and degree of the forces<br />Injuries can possibly be life-threatening<br />
  64. 64. Diagnosis…<br />X-Rays<br />CT scans<br />Blood vessels and nerves<br />
  65. 65. Treatment….<br /> Nonsurgical<br /> Stable fracture<br /> Use of crutches or walker <br /> Partial weight bearing up to 3 months<br />
  66. 66. Treatments…<br />Surgical<br /> Unstable fractures <br /> External fixator<br /> Traction <br /> Plates and screws <br />
  67. 67. Outcomes….<br />Stable vs. non-stable<br />Gait<br />Subsequent Problems<br /> pain<br />Impaired mobility<br /> Sexual dysfunction <br />
  68. 68. Thank you<br />

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