SlideShare a Scribd company logo
1 of 45
Download to read offline
Lower limb
fractures
Tibia, Ankle, Foot.
Given Sishekano
201404386
MBChB IV
Feb 17,2017
14h00
Table of content
▪ Fractures of the tibia
▪ Fractures of the ankle
▪ Fractures of the foot
Tibial fractures
▪ 1. Anatomy
▪ 2. Proximal tibia fractures
▪ 3. Tibial shaft fractures.
▪ 4. Distal tibia fractures
Anatomy
• Long & Tubular w/ a triangular cross
section.
• Subcutaneous anteromedial border.
Fractures of the proximal tibia.
1. Fractures of tibial plateau
▪ Usually caused by forcible Valgus or Varus strain.
▪ Low energy fractures common in older females due to osteoporotic bone
changes.
▪ High energy fractures are commonly the result of motor vehicle
accidents, falls or sports related injuries
▪ Strong bending forces combined with an axial load e.g. bumper fractures
▪ A fall from a height in which the knee is forced into valgus or varus
position
▪ Lateral tibial plateu is commonly affected but medial may also be
affected
Epidemiology & presentation
▪ 50% of presenting pts are over 50 y/o (females commonly)
▪ Patients present with severe tenderness on side of fracture and on
opposing side if tendon damaged.
▪ Swollen tendon with doughy feel due to haemarthrosis
Classification (Schatzker Classification)
Imaging
▪ X-rays are vital
▪ CT scan not always done but help in evaluating extent of fracture
and planning management.
▪ MRI scan if soft tissue damage is suspected
▪ CT angiography if concerns of vascular compromise
Management
▪ Treatment is aimed at achieving a stable, aligned, mobile and
painless joint and to minimize the risk of posttraumatic
osteoarthritis.
▪ Undisplaced & minimally displaced(Lc): conservative
management.
▪ Marked displacement/ comminuted(Lc): ORIF
▪ Medial condyle fractures: ORIF
▪ Bicondylar fractures: internal fixation w/ Plates and screws
Tibial Shaft Fractures
▪ Commonest long bone fractures.
▪ Men>women
▪ Often Open fractures w/ contaminated wound.
Mechanism of Injury
▪ 1.Direct: High energy: MVA, sporting injury
-Transverse, comminuted, displaced fractures commonly occur.
-Incidence of soft tissue trauma is high
▪ Penetrating: gunshot-The injury pattern is variable.
▪ Bending-Short oblique or transverse fractures occur, with a
possible butterfly fragment.
-Crush injury.
▪ 2. Indirect
▪ Torsional mechanisms
-twisting with foot fixed, falls from low height.
-minimal soft tissue damage.
▪ Stress fractures
-e.g in Ballet dancers.
Clinical Exam
▪ Neurovascular status
▪ Assess soft tissue injury
▪ Examine knee ligament(commonly damaged)
▪ Examine for signs of compartment syndrome.
Imaging
▪ X-ray is usually sufficient
-Two views
-Two joints
-Two occasions
▪ Oblique X-ray to characterise pattern of injury if necessary.
▪ Post reduction X-ray must be done.
Classification
▪ None Universal.
▪ If open-Gustillo Anderson
▪ If closed- Tscherne Classification
of closed fractures.
Management
▪ Low energy
-Gastillo I, II: Conservatively
▪ Undisplaced/minimally displaced
- full length cast from upper thigh
to metatarsal neck, knee is
slightly flexed and the ankle at a
right angle
▪ Displaced fracture
- reduction under general
anaesthesia
▪ High energy
-External fixation is the method of
choice
-intramedullary nailing is an
alternative
-- Open operations should be
avoided unless there is already an
open wound
Complications
▪ Vascular injuries
▪ Compartment syndrome
▪ Infection
▪ Malunion
▪ Delayed union and non union
▪ Joint stiffness
3. Distal Tibial fractures
▪ Injury occurs when a large axial force drives the talus upwards
against the tibial plafond
▪ Usually high Energy
▪ Can be rotational with lower energy
▪ Articular Surface is Involved
▪ Can have severe comminution and severe soft tissue injury
Clinical features
▪ Little swelling initially but this rapidly changes
▪ Fracture blisters are common
▪ Ankle may be deformed or dislocated
Classification(Rudi and Allgower)
▪ Type I – Fracture involving
minimal displacement
▪ Type II – Significant
displacement of the joint surface
▪ Type III – Impaction and
comminution of the articular
surface
Imaging
▪ X-ray(diagnostic)
Management
▪ Early management: SPAN, SCAN,
PLAN.
▪ Remember Life, Limb, Fracture.
▪ Manage soft tissue swelling.
▪ Once skin has recovered, do ORIF
▪ Closed reduction w/ a cast.
▪ External fixation if needed
2. Ankle fractures
▪ Anatomy of the ankle ▪ Tibia and fibula form a mortise
which provides a constrained
articulation for the talus.
▪ Ankle stability is provided by 3
factors:
▪ Bony architecture, joint capsule and
ligamentous
▪ structures:
▪ Syndesmotic ligaments
▪ Medial collateral ligaments
▪ Lateral collateral ligaments
▪ Stumbling and falling
-Foot is usually anchored to the ground and the body lounges
forward.
▪ Ankle twisting
-Talus tilts or rotates forcibly in mortise causing a low energy
fracture of one or both malleoli with associated injuries of the
ligaments.
▪ Simple description:
▪ Joint can be injured on one side only
(single malleolus) or on both sides
(bi-malleolar fracture)
▪ Rotational injuries:
▪ 1/both sides may be injured.
▪ Posterior lip of the lower end of the
tibia (posterior malleolus) may be
fractured.
▪ Degree of instability depends on
how much of ankle complex is
damaged.
Classification
1. Weber classification
2. LAUGE-HANSEN CLASSIFICATION:
Uses two terms:
First: describes position of the foot at time of injury, second: the motion of the talus relative to the tibia
Types:
1. supination – adduction
2. supination – external rotation
3. pronation – abduction
4. pronation – eversion
5. pronation – dorsiflexion
Description is used because most ankle injuries are caused by the weight of the falling person applying
force on the ankle with the foot in a fixed position.
Classification proposes that mechanism of injury can be deduced from the X-ray appearances and that
reduction involves applying the reverse movement.
3. Fractures of the foot
▪ Anatomy of the foot.
Talus fracture
▪ Talus fracture is an injury of the hind
foot
▪ Rare, occur due to considerable
violence with axial loading or hyper
dorsiflexion.
▪ Injuries include fracture of the head,
neck, body, or bony processes of
talus.
▪ Patients present with painful and
swollen foot and ankle
▪ Obvious deformity if fracture is
displaced
▪ Skin overlaying the fracture or
dislocation may be tented or split
X-ray(Talus fracture)
Hawkins Classification & management
▪ Type I : non displaced fracture
▪ Type II : displaced fracture with
subluxation or dislocation of the
subtalar joint and a normal ankle
joint
▪ Type III : displaced fracture with
body of talus dislocated from both
subtalar and ankle joint.
▪ Type IV: in addition to features
describes in type III there is
dislocation or subluxation of the
head of the talus at the
talonavicular joint
Management
▪ Undisplaced #: Backslab until
swelling has subsided followed by
non-weight bearing below knee
CPOP (6-8 weeks)
▪ Displaced #: closed reduction
attempted first, if it fails, ORIF is
performed where the reduced # is
stabilised with 1 or 2 lag screws
Complications
-Malunion
-AVN
-Secondary Osteoarthritis
Calcaneal fractures
▪ Common mechanism axial loading
▪ Calcaneum driven up against talus and
is split or crushed.
▪ 10% of calcaneus #s associated with
compression injuries of spine, pelvis or
hip.
▪ Two types:
▪ Extra-articular #: involve calcaneal
processes or posterior part of bone.
Easy to manage and have good
prognosis.
▪ Intra-articular #: cleave bone obliquely
and run into superior articular surface.
Articular facet is split apart and there
may be severe comminution.
Sanders Classification
▪ Type I: non-displaced fractures (displacement < 2 mm).
▪ Type II: consist of single intraarticular fracture dividing the
calcaneus into 2 pieces.
▪ Type IIA: occurs on lateral aspect of calcaneus.
▪ Type IIB: occurs on central aspect of calcaneus.
▪ Type IIC: occurs on medial aspect of calcaneus.
▪ Type III: consist of two intraarticular fractures that divide the
calcaneus into 3 pieces.
▪ Type IIIAB: two fracture lines are present, one lateral and one
central.
▪ Type IIIAC: two fracture lines are present, one lateral and one
medial.
▪ Type IIIBC: two fracture lines are present, one central and one
medial.
▪ Type IV fractures consist of fractures with more than three
intrarticular fractures.
Presentation
▪ Foot is painful, swollen and bruised.
▪ Wider, shortened, flatter heel when
viewed from behind + varus heel
▪ Tissues are thick and tender and
normal concavity below the lateral
malleolus is lacking.
▪ Subtalar joint cannot be moved but
ankle movement is possible.
▪ Always check for signs of
Compartment syndrome
X-ray views
▪ Lateral, oblique and AP views
▪ Extra-articular #: fairly obvious on
xray
▪ Intra-articular #: can be identified
on xray, if there is displacement of
fragments lateral view may show
reduced of Bohler’s angle
Management
▪ Undisplaced fractures: Closed non-surgical treatment (backslab,
CPOP), use crutches for 4-6 weeks.
▪ Displaced avulsion #: ORIF, Immobilise foot in slight equinus to
relieve tension on tendo Achillis. Non-weight bearing for 4-6 weeks.
▪ Displaced intra-articular #: ORIF with plates and screws.
▪ Bone grafts may be used to fill defects.
▪ Encourage exercise when pain subsides
▪ Pt allowed to use crutches 2-3 weeks after (non-weight bearing) ->
Partial weight bearing only when fracture has healed -> full weight
bearing only 4 weeks after that
Complications
▪ Early: swelling and blistering, Compartment Syndrome
▪ Late: Malunion, Insufficiency of Achilles tendon (due to loss of
heel height), talocalcaneal stiffness and osteoarthritis
Lisfranc fracture
▪ Lisfranc (midfoot) injuries result if bones in the midfoot are broken or
ligaments that support the midfoot are torn.
▪ Varies from minor sprains to severe fracture-dislocations
▪ m.o.i: simple twist and fall.
▪ This is a low-energy injury, commonly seen in football and soccer players.
▪ More severe injuries occur from direct trauma, such as a fall from a
height.
▪ These high-energy injuries can result in multiple fractures and
dislocations of the joints.
▪ It is often seen when someone stumbles over the top of a foot plantar
flexed.
Mechanism of injury
Symptoms
• Pain(worsened by
walking)
• Bruising
• Swelling
X-rays
▪ Full extent of injury hardly clear on plain x-ray; multiple vies of CT
may be needed.
▪ Look out for fractures of navicular and cuneiform bones.
Management
▪ Undisplaced sprain: cast immobilization for 4-6 weeks.
▪ Subluxation and dislocation: Traction and manipulation under
anaesthesia achieves reduction.
▪ Position is then held with K-wires or screws and cast
immobilization.
▪ Non-weight bearing for 6-8 weeks.
Metatarsal fractures
▪ Due to direct blow, severe
twisting injury or repetitive stress
▪ 5th metatarsal #s are usually
due to forced inversion of the
foot (the pot hole injury) which
then causes avulsion of the base
of the 5th metatarsal tuberosity
▪ Avulsion fracture occurs where a
tendon attaches to the bone
▪ When an avulsion fracture
occurs, the tendon pulls off a tiny
fragment of bone.
Presentation
▪ Patient often complains of
having sprained the ankle
▪ Tenderness marked over area of
fracture.
Management
▪ Fracture usually unites readily
▪ Immobilisation in a below knee
plaster for 4 weeks is advised
X-rays
Sesamoid fractures
▪ Fractures occur either due to a direct injury (i.e landing from a
height on the ball of the foot), sudden traction or;
▪ chronic repetitive stress as seen in dancers and runners
▪ Patient c/o pain over the sesamoids
▪ O/E: Tender spot in the same area and pain may be exacerbated
by passively hyperextending the hallux
Rx:Conservative treatment
▪ Use of local lignocaine injection for pain relief
▪ In cases of marked discomfort, immobilise leg in cast 2-3 weeks
References
1. Apley’s consice system of orthopaedics and fractures
2. Toronto notes 2016
3. Orthopaedics and fractures lecture notes(4th ed.), wiley-Blackwell.

More Related Content

What's hot

Fracture of Proximal Tibia
Fracture of Proximal TibiaFracture of Proximal Tibia
Fracture of Proximal TibiaEneutron
 
Recurrent Dislocation of patella -PAWAN
Recurrent Dislocation of patella -PAWANRecurrent Dislocation of patella -PAWAN
Recurrent Dislocation of patella -PAWANPawan Yadav
 
Bennetts Fracture
Bennetts FractureBennetts Fracture
Bennetts Fracturejfreshour
 
Fracture both bones leg class ug
Fracture both bones leg class ugFracture both bones leg class ug
Fracture both bones leg class ugSarthy Velayutham
 
Meniscal injury
Meniscal injuryMeniscal injury
Meniscal injurymanoj das
 
monteggia fracture
 monteggia fracture monteggia fracture
monteggia fractureGaurav Mehta
 
4. humerus fractures
4. humerus fractures4. humerus fractures
4. humerus fracturesFahad Zakwan
 
Classification of spinal fracture
Classification of spinal fractureClassification of spinal fracture
Classification of spinal fractureBipulBorthakur
 
Anterior cruciate ligament-Injury & management
Anterior cruciate ligament-Injury & managementAnterior cruciate ligament-Injury & management
Anterior cruciate ligament-Injury & managementAnand Rao
 
Elbow dislocations
Elbow dislocationsElbow dislocations
Elbow dislocationsAjith John
 

What's hot (20)

Whiplash injury
Whiplash injuryWhiplash injury
Whiplash injury
 
Fracture of Proximal Tibia
Fracture of Proximal TibiaFracture of Proximal Tibia
Fracture of Proximal Tibia
 
Forearm fractures
Forearm fracturesForearm fractures
Forearm fractures
 
Elbow dislocations
Elbow dislocationsElbow dislocations
Elbow dislocations
 
Clavicle fracture
Clavicle fractureClavicle fracture
Clavicle fracture
 
Recurrent Dislocation of patella -PAWAN
Recurrent Dislocation of patella -PAWANRecurrent Dislocation of patella -PAWAN
Recurrent Dislocation of patella -PAWAN
 
Bennetts Fracture
Bennetts FractureBennetts Fracture
Bennetts Fracture
 
Fracture of Upper Limb
Fracture of Upper LimbFracture of Upper Limb
Fracture of Upper Limb
 
Fracture both bones leg class ug
Fracture both bones leg class ugFracture both bones leg class ug
Fracture both bones leg class ug
 
Meniscal injury
Meniscal injuryMeniscal injury
Meniscal injury
 
Humeral shaft fractures
Humeral shaft fracturesHumeral shaft fractures
Humeral shaft fractures
 
monteggia fracture
 monteggia fracture monteggia fracture
monteggia fracture
 
Tuberculosis of Hip Joint
Tuberculosis of Hip JointTuberculosis of Hip Joint
Tuberculosis of Hip Joint
 
Distal radius fractures
Distal radius fracturesDistal radius fractures
Distal radius fractures
 
4. humerus fractures
4. humerus fractures4. humerus fractures
4. humerus fractures
 
Classification of spinal fracture
Classification of spinal fractureClassification of spinal fracture
Classification of spinal fracture
 
Elbow dislocation
Elbow dislocationElbow dislocation
Elbow dislocation
 
Anterior cruciate ligament-Injury & management
Anterior cruciate ligament-Injury & managementAnterior cruciate ligament-Injury & management
Anterior cruciate ligament-Injury & management
 
Elbow dislocations
Elbow dislocationsElbow dislocations
Elbow dislocations
 
Monteggia ppt
Monteggia pptMonteggia ppt
Monteggia ppt
 

Viewers also liked

Common childhood problems of the lower limb (cong. &amp; dev.)
Common childhood problems of the lower limb (cong. &amp; dev.)Common childhood problems of the lower limb (cong. &amp; dev.)
Common childhood problems of the lower limb (cong. &amp; dev.)Given Sishekano
 
Hospital acquired infections
Hospital acquired infectionsHospital acquired infections
Hospital acquired infectionsGiven Sishekano
 
The medical students association of namibia
The medical students association of namibiaThe medical students association of namibia
The medical students association of namibiaGiven Sishekano
 
Chronic osteomyelitis
Chronic osteomyelitisChronic osteomyelitis
Chronic osteomyelitisSanjay Alle
 
upper limb Fractures and dislocations
upper limb Fractures and dislocationsupper limb Fractures and dislocations
upper limb Fractures and dislocationsakifab93
 
Mch Program Offered by Texila American University
Mch Program Offered by Texila American UniversityMch Program Offered by Texila American University
Mch Program Offered by Texila American UniversityTexila141
 
Clean hands clean heart
Clean hands clean heartClean hands clean heart
Clean hands clean heartflemingant
 
Final pediatric emergency ultrasonography
Final pediatric emergency ultrasonographyFinal pediatric emergency ultrasonography
Final pediatric emergency ultrasonographyKate Moreng
 
Emergency Room Notes
Emergency Room NotesEmergency Room Notes
Emergency Room NotesLEDocDave
 
Handwashing Jeopardy Game
Handwashing Jeopardy GameHandwashing Jeopardy Game
Handwashing Jeopardy Gamekligutom
 
Supracondylar Fracture
Supracondylar FractureSupracondylar Fracture
Supracondylar FractureTodd Peterson
 
Galeazzi fracture Power Point
Galeazzi fracture Power PointGaleazzi fracture Power Point
Galeazzi fracture Power PointTodd Peterson
 
Common Urological Emergencies
Common Urological EmergenciesCommon Urological Emergencies
Common Urological EmergenciesMazin Eragat
 
Chronic osteomyeliti sby aina
Chronic osteomyeliti sby ainaChronic osteomyeliti sby aina
Chronic osteomyeliti sby ainaainakadir
 
Day 2 | CME- Trauma Symposium | Master trauma panel perspective
Day 2 | CME- Trauma Symposium | Master trauma panel perspectiveDay 2 | CME- Trauma Symposium | Master trauma panel perspective
Day 2 | CME- Trauma Symposium | Master trauma panel perspectiveNorton Healthcare
 
Jeopardy: Principles of Emergency Medicine
Jeopardy: Principles of Emergency Medicine Jeopardy: Principles of Emergency Medicine
Jeopardy: Principles of Emergency Medicine oliver0618
 
Role of us in pelvic pain final
Role of us in pelvic pain finalRole of us in pelvic pain final
Role of us in pelvic pain finalnasrat1949
 

Viewers also liked (20)

Common childhood problems of the lower limb (cong. &amp; dev.)
Common childhood problems of the lower limb (cong. &amp; dev.)Common childhood problems of the lower limb (cong. &amp; dev.)
Common childhood problems of the lower limb (cong. &amp; dev.)
 
Hospital acquired infections
Hospital acquired infectionsHospital acquired infections
Hospital acquired infections
 
The medical students association of namibia
The medical students association of namibiaThe medical students association of namibia
The medical students association of namibia
 
Chronic osteomyelitis
Chronic osteomyelitisChronic osteomyelitis
Chronic osteomyelitis
 
upper limb Fractures and dislocations
upper limb Fractures and dislocationsupper limb Fractures and dislocations
upper limb Fractures and dislocations
 
Disorders of upper limb
Disorders of upper limbDisorders of upper limb
Disorders of upper limb
 
Disorders of Lower Limb
Disorders of Lower LimbDisorders of Lower Limb
Disorders of Lower Limb
 
Mch Program Offered by Texila American University
Mch Program Offered by Texila American UniversityMch Program Offered by Texila American University
Mch Program Offered by Texila American University
 
Clean hands clean heart
Clean hands clean heartClean hands clean heart
Clean hands clean heart
 
Final pediatric emergency ultrasonography
Final pediatric emergency ultrasonographyFinal pediatric emergency ultrasonography
Final pediatric emergency ultrasonography
 
Emergency Room Notes
Emergency Room NotesEmergency Room Notes
Emergency Room Notes
 
Handwashing Jeopardy Game
Handwashing Jeopardy GameHandwashing Jeopardy Game
Handwashing Jeopardy Game
 
Commonly missed Fractures
Commonly missed FracturesCommonly missed Fractures
Commonly missed Fractures
 
Supracondylar Fracture
Supracondylar FractureSupracondylar Fracture
Supracondylar Fracture
 
Galeazzi fracture Power Point
Galeazzi fracture Power PointGaleazzi fracture Power Point
Galeazzi fracture Power Point
 
Common Urological Emergencies
Common Urological EmergenciesCommon Urological Emergencies
Common Urological Emergencies
 
Chronic osteomyeliti sby aina
Chronic osteomyeliti sby ainaChronic osteomyeliti sby aina
Chronic osteomyeliti sby aina
 
Day 2 | CME- Trauma Symposium | Master trauma panel perspective
Day 2 | CME- Trauma Symposium | Master trauma panel perspectiveDay 2 | CME- Trauma Symposium | Master trauma panel perspective
Day 2 | CME- Trauma Symposium | Master trauma panel perspective
 
Jeopardy: Principles of Emergency Medicine
Jeopardy: Principles of Emergency Medicine Jeopardy: Principles of Emergency Medicine
Jeopardy: Principles of Emergency Medicine
 
Role of us in pelvic pain final
Role of us in pelvic pain finalRole of us in pelvic pain final
Role of us in pelvic pain final
 

Similar to Lower limb fractures-Orthopedics

Acute knee ligament injuries
Acute knee ligament injuriesAcute knee ligament injuries
Acute knee ligament injuriesMilind Merchant
 
Ankle and foot injuries
Ankle and foot injuriesAnkle and foot injuries
Ankle and foot injuriesAmardeep kaur
 
ankle injuries.pptx
ankle injuries.pptxankle injuries.pptx
ankle injuries.pptxApoorvBiswas
 
ankleandfootinjuries-110514115858-phpapp01.pdf
ankleandfootinjuries-110514115858-phpapp01.pdfankleandfootinjuries-110514115858-phpapp01.pdf
ankleandfootinjuries-110514115858-phpapp01.pdfHarmonyOyiko
 
fractureoftalusppt-170408155144.pdf
fractureoftalusppt-170408155144.pdffractureoftalusppt-170408155144.pdf
fractureoftalusppt-170408155144.pdfSachinK102415
 
PPT trauma muskuloskeletal dr. Satria, Sp.OT.pptx
PPT trauma muskuloskeletal dr. Satria, Sp.OT.pptxPPT trauma muskuloskeletal dr. Satria, Sp.OT.pptx
PPT trauma muskuloskeletal dr. Satria, Sp.OT.pptxSebastianMihardja1
 
Ligament injury to knee: ACL
Ligament injury to knee: ACLLigament injury to knee: ACL
Ligament injury to knee: ACLSijan Bhattachan
 
FRACTURE OF THE SHAFT OF THE FEMUR.ppt
FRACTURE OF THE SHAFT OF THE FEMUR.pptFRACTURE OF THE SHAFT OF THE FEMUR.ppt
FRACTURE OF THE SHAFT OF THE FEMUR.pptnandhana48
 
Commen injuries of lower limbs
Commen injuries of lower limbsCommen injuries of lower limbs
Commen injuries of lower limbsDrHiba M
 
SPORTS INJURIES OF ANKLE AND FOOT original.pptx
SPORTS INJURIES OF ANKLE AND FOOT original.pptxSPORTS INJURIES OF ANKLE AND FOOT original.pptx
SPORTS INJURIES OF ANKLE AND FOOT original.pptxMeghaPrakash9
 
Hip dislocations and femoral head fractures
Hip dislocations and femoral head fracturesHip dislocations and femoral head fractures
Hip dislocations and femoral head fracturesAhmed Ashour dr.
 
ankle sprain presentation.pdf
ankle sprain presentation.pdfankle sprain presentation.pdf
ankle sprain presentation.pdfAshrafHussein36
 

Similar to Lower limb fractures-Orthopedics (20)

Acute knee ligament injuries
Acute knee ligament injuriesAcute knee ligament injuries
Acute knee ligament injuries
 
Ankle and foot injuries
Ankle and foot injuriesAnkle and foot injuries
Ankle and foot injuries
 
ankle injuries.pptx
ankle injuries.pptxankle injuries.pptx
ankle injuries.pptx
 
Hip dislocation
Hip dislocationHip dislocation
Hip dislocation
 
Hip dislocation
Hip dislocationHip dislocation
Hip dislocation
 
ankleandfootinjuries-110514115858-phpapp01.pdf
ankleandfootinjuries-110514115858-phpapp01.pdfankleandfootinjuries-110514115858-phpapp01.pdf
ankleandfootinjuries-110514115858-phpapp01.pdf
 
Orthopedics 2
Orthopedics 2Orthopedics 2
Orthopedics 2
 
Elbow and forearm fractures
Elbow and forearm fracturesElbow and forearm fractures
Elbow and forearm fractures
 
Fracture of talus ppt
Fracture of talus pptFracture of talus ppt
Fracture of talus ppt
 
fractureoftalusppt-170408155144.pdf
fractureoftalusppt-170408155144.pdffractureoftalusppt-170408155144.pdf
fractureoftalusppt-170408155144.pdf
 
Hip dislocation class
Hip dislocation classHip dislocation class
Hip dislocation class
 
Closed ankle injuries
Closed ankle injuriesClosed ankle injuries
Closed ankle injuries
 
PPT trauma muskuloskeletal dr. Satria, Sp.OT.pptx
PPT trauma muskuloskeletal dr. Satria, Sp.OT.pptxPPT trauma muskuloskeletal dr. Satria, Sp.OT.pptx
PPT trauma muskuloskeletal dr. Satria, Sp.OT.pptx
 
Ligament injury to knee: ACL
Ligament injury to knee: ACLLigament injury to knee: ACL
Ligament injury to knee: ACL
 
FRACTURE OF THE SHAFT OF THE FEMUR.ppt
FRACTURE OF THE SHAFT OF THE FEMUR.pptFRACTURE OF THE SHAFT OF THE FEMUR.ppt
FRACTURE OF THE SHAFT OF THE FEMUR.ppt
 
Commen injuries of lower limbs
Commen injuries of lower limbsCommen injuries of lower limbs
Commen injuries of lower limbs
 
Ankle injuries
Ankle injuriesAnkle injuries
Ankle injuries
 
SPORTS INJURIES OF ANKLE AND FOOT original.pptx
SPORTS INJURIES OF ANKLE AND FOOT original.pptxSPORTS INJURIES OF ANKLE AND FOOT original.pptx
SPORTS INJURIES OF ANKLE AND FOOT original.pptx
 
Hip dislocations and femoral head fractures
Hip dislocations and femoral head fracturesHip dislocations and femoral head fractures
Hip dislocations and femoral head fractures
 
ankle sprain presentation.pdf
ankle sprain presentation.pdfankle sprain presentation.pdf
ankle sprain presentation.pdf
 

Recently uploaded

SCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
SCHOOL HEALTH SERVICES.pptx made by Sapna ThakurSCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
SCHOOL HEALTH SERVICES.pptx made by Sapna ThakurSapna Thakur
 
Presentation on General Anesthetics pdf.
Presentation on General Anesthetics pdf.Presentation on General Anesthetics pdf.
Presentation on General Anesthetics pdf.Prerana Jadhav
 
SHOCK (Medical SURGICAL BASED EDITION)).pptx
SHOCK (Medical SURGICAL BASED EDITION)).pptxSHOCK (Medical SURGICAL BASED EDITION)).pptx
SHOCK (Medical SURGICAL BASED EDITION)).pptxAbhishek943418
 
Plant Fibres used as Surgical Dressings PDF.pdf
Plant Fibres used as Surgical Dressings PDF.pdfPlant Fibres used as Surgical Dressings PDF.pdf
Plant Fibres used as Surgical Dressings PDF.pdfDivya Kanojiya
 
Musculoskeletal disorders: Osteoarthritis,.pptx
Musculoskeletal disorders: Osteoarthritis,.pptxMusculoskeletal disorders: Osteoarthritis,.pptx
Musculoskeletal disorders: Osteoarthritis,.pptxraviapr7
 
Informed Consent Empowering Healthcare Decision-Making.pptx
Informed Consent Empowering Healthcare Decision-Making.pptxInformed Consent Empowering Healthcare Decision-Making.pptx
Informed Consent Empowering Healthcare Decision-Making.pptxSasikiranMarri
 
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptxSYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptxdrashraf369
 
epilepsy and status epilepticus for undergraduate.pptx
epilepsy and status epilepticus  for undergraduate.pptxepilepsy and status epilepticus  for undergraduate.pptx
epilepsy and status epilepticus for undergraduate.pptxMohamed Rizk Khodair
 
PULMONARY EDEMA AND ITS MANAGEMENT.pdf
PULMONARY EDEMA AND  ITS  MANAGEMENT.pdfPULMONARY EDEMA AND  ITS  MANAGEMENT.pdf
PULMONARY EDEMA AND ITS MANAGEMENT.pdfDolisha Warbi
 
Hypersensitivity and its classification .pptx
Hypersensitivity and its classification .pptxHypersensitivity and its classification .pptx
Hypersensitivity and its classification .pptxAkshay Shetty
 
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdfSGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdfHongBiThi1
 
Biomechanics- Shoulder Joint!!!!!!!!!!!!
Biomechanics- Shoulder Joint!!!!!!!!!!!!Biomechanics- Shoulder Joint!!!!!!!!!!!!
Biomechanics- Shoulder Joint!!!!!!!!!!!!ibtesaam huma
 
The next social challenge to public health: the information environment.pptx
The next social challenge to public health:  the information environment.pptxThe next social challenge to public health:  the information environment.pptx
The next social challenge to public health: the information environment.pptxTina Purnat
 
Introduction to Sports Injuries by- Dr. Anjali Rai
Introduction to Sports Injuries by- Dr. Anjali RaiIntroduction to Sports Injuries by- Dr. Anjali Rai
Introduction to Sports Injuries by- Dr. Anjali RaiGoogle
 
Role of medicinal and aromatic plants in national economy PDF.pdf
Role of medicinal and aromatic plants in national economy PDF.pdfRole of medicinal and aromatic plants in national economy PDF.pdf
Role of medicinal and aromatic plants in national economy PDF.pdfDivya Kanojiya
 
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)MohamadAlhes
 
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic Analysis
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic AnalysisVarSeq 2.6.0: Advancing Pharmacogenomics and Genomic Analysis
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic AnalysisGolden Helix
 
Chronic-Fatigue-Syndrome-CFS-Understanding-a-Complex-Disorder.pptx
Chronic-Fatigue-Syndrome-CFS-Understanding-a-Complex-Disorder.pptxChronic-Fatigue-Syndrome-CFS-Understanding-a-Complex-Disorder.pptx
Chronic-Fatigue-Syndrome-CFS-Understanding-a-Complex-Disorder.pptxSasikiranMarri
 
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptx
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptxPresentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptx
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptxpdamico1
 
Culture and Health Disorders Social change.pptx
Culture and Health Disorders Social change.pptxCulture and Health Disorders Social change.pptx
Culture and Health Disorders Social change.pptxDr. Dheeraj Kumar
 

Recently uploaded (20)

SCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
SCHOOL HEALTH SERVICES.pptx made by Sapna ThakurSCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
SCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
 
Presentation on General Anesthetics pdf.
Presentation on General Anesthetics pdf.Presentation on General Anesthetics pdf.
Presentation on General Anesthetics pdf.
 
SHOCK (Medical SURGICAL BASED EDITION)).pptx
SHOCK (Medical SURGICAL BASED EDITION)).pptxSHOCK (Medical SURGICAL BASED EDITION)).pptx
SHOCK (Medical SURGICAL BASED EDITION)).pptx
 
Plant Fibres used as Surgical Dressings PDF.pdf
Plant Fibres used as Surgical Dressings PDF.pdfPlant Fibres used as Surgical Dressings PDF.pdf
Plant Fibres used as Surgical Dressings PDF.pdf
 
Musculoskeletal disorders: Osteoarthritis,.pptx
Musculoskeletal disorders: Osteoarthritis,.pptxMusculoskeletal disorders: Osteoarthritis,.pptx
Musculoskeletal disorders: Osteoarthritis,.pptx
 
Informed Consent Empowering Healthcare Decision-Making.pptx
Informed Consent Empowering Healthcare Decision-Making.pptxInformed Consent Empowering Healthcare Decision-Making.pptx
Informed Consent Empowering Healthcare Decision-Making.pptx
 
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptxSYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
 
epilepsy and status epilepticus for undergraduate.pptx
epilepsy and status epilepticus  for undergraduate.pptxepilepsy and status epilepticus  for undergraduate.pptx
epilepsy and status epilepticus for undergraduate.pptx
 
PULMONARY EDEMA AND ITS MANAGEMENT.pdf
PULMONARY EDEMA AND  ITS  MANAGEMENT.pdfPULMONARY EDEMA AND  ITS  MANAGEMENT.pdf
PULMONARY EDEMA AND ITS MANAGEMENT.pdf
 
Hypersensitivity and its classification .pptx
Hypersensitivity and its classification .pptxHypersensitivity and its classification .pptx
Hypersensitivity and its classification .pptx
 
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdfSGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
 
Biomechanics- Shoulder Joint!!!!!!!!!!!!
Biomechanics- Shoulder Joint!!!!!!!!!!!!Biomechanics- Shoulder Joint!!!!!!!!!!!!
Biomechanics- Shoulder Joint!!!!!!!!!!!!
 
The next social challenge to public health: the information environment.pptx
The next social challenge to public health:  the information environment.pptxThe next social challenge to public health:  the information environment.pptx
The next social challenge to public health: the information environment.pptx
 
Introduction to Sports Injuries by- Dr. Anjali Rai
Introduction to Sports Injuries by- Dr. Anjali RaiIntroduction to Sports Injuries by- Dr. Anjali Rai
Introduction to Sports Injuries by- Dr. Anjali Rai
 
Role of medicinal and aromatic plants in national economy PDF.pdf
Role of medicinal and aromatic plants in national economy PDF.pdfRole of medicinal and aromatic plants in national economy PDF.pdf
Role of medicinal and aromatic plants in national economy PDF.pdf
 
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
 
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic Analysis
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic AnalysisVarSeq 2.6.0: Advancing Pharmacogenomics and Genomic Analysis
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic Analysis
 
Chronic-Fatigue-Syndrome-CFS-Understanding-a-Complex-Disorder.pptx
Chronic-Fatigue-Syndrome-CFS-Understanding-a-Complex-Disorder.pptxChronic-Fatigue-Syndrome-CFS-Understanding-a-Complex-Disorder.pptx
Chronic-Fatigue-Syndrome-CFS-Understanding-a-Complex-Disorder.pptx
 
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptx
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptxPresentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptx
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptx
 
Culture and Health Disorders Social change.pptx
Culture and Health Disorders Social change.pptxCulture and Health Disorders Social change.pptx
Culture and Health Disorders Social change.pptx
 

Lower limb fractures-Orthopedics

  • 1. Lower limb fractures Tibia, Ankle, Foot. Given Sishekano 201404386 MBChB IV Feb 17,2017 14h00
  • 2. Table of content ▪ Fractures of the tibia ▪ Fractures of the ankle ▪ Fractures of the foot
  • 3. Tibial fractures ▪ 1. Anatomy ▪ 2. Proximal tibia fractures ▪ 3. Tibial shaft fractures. ▪ 4. Distal tibia fractures
  • 4. Anatomy • Long & Tubular w/ a triangular cross section. • Subcutaneous anteromedial border.
  • 5. Fractures of the proximal tibia. 1. Fractures of tibial plateau ▪ Usually caused by forcible Valgus or Varus strain. ▪ Low energy fractures common in older females due to osteoporotic bone changes. ▪ High energy fractures are commonly the result of motor vehicle accidents, falls or sports related injuries ▪ Strong bending forces combined with an axial load e.g. bumper fractures ▪ A fall from a height in which the knee is forced into valgus or varus position ▪ Lateral tibial plateu is commonly affected but medial may also be affected
  • 6. Epidemiology & presentation ▪ 50% of presenting pts are over 50 y/o (females commonly) ▪ Patients present with severe tenderness on side of fracture and on opposing side if tendon damaged. ▪ Swollen tendon with doughy feel due to haemarthrosis
  • 8. Imaging ▪ X-rays are vital ▪ CT scan not always done but help in evaluating extent of fracture and planning management. ▪ MRI scan if soft tissue damage is suspected ▪ CT angiography if concerns of vascular compromise
  • 9. Management ▪ Treatment is aimed at achieving a stable, aligned, mobile and painless joint and to minimize the risk of posttraumatic osteoarthritis. ▪ Undisplaced & minimally displaced(Lc): conservative management. ▪ Marked displacement/ comminuted(Lc): ORIF ▪ Medial condyle fractures: ORIF ▪ Bicondylar fractures: internal fixation w/ Plates and screws
  • 10. Tibial Shaft Fractures ▪ Commonest long bone fractures. ▪ Men>women ▪ Often Open fractures w/ contaminated wound.
  • 11. Mechanism of Injury ▪ 1.Direct: High energy: MVA, sporting injury -Transverse, comminuted, displaced fractures commonly occur. -Incidence of soft tissue trauma is high ▪ Penetrating: gunshot-The injury pattern is variable. ▪ Bending-Short oblique or transverse fractures occur, with a possible butterfly fragment. -Crush injury.
  • 12. ▪ 2. Indirect ▪ Torsional mechanisms -twisting with foot fixed, falls from low height. -minimal soft tissue damage. ▪ Stress fractures -e.g in Ballet dancers.
  • 13.
  • 14. Clinical Exam ▪ Neurovascular status ▪ Assess soft tissue injury ▪ Examine knee ligament(commonly damaged) ▪ Examine for signs of compartment syndrome.
  • 15. Imaging ▪ X-ray is usually sufficient -Two views -Two joints -Two occasions ▪ Oblique X-ray to characterise pattern of injury if necessary. ▪ Post reduction X-ray must be done.
  • 16. Classification ▪ None Universal. ▪ If open-Gustillo Anderson ▪ If closed- Tscherne Classification of closed fractures.
  • 17. Management ▪ Low energy -Gastillo I, II: Conservatively ▪ Undisplaced/minimally displaced - full length cast from upper thigh to metatarsal neck, knee is slightly flexed and the ankle at a right angle ▪ Displaced fracture - reduction under general anaesthesia ▪ High energy -External fixation is the method of choice -intramedullary nailing is an alternative -- Open operations should be avoided unless there is already an open wound
  • 18. Complications ▪ Vascular injuries ▪ Compartment syndrome ▪ Infection ▪ Malunion ▪ Delayed union and non union ▪ Joint stiffness
  • 19. 3. Distal Tibial fractures ▪ Injury occurs when a large axial force drives the talus upwards against the tibial plafond ▪ Usually high Energy ▪ Can be rotational with lower energy ▪ Articular Surface is Involved ▪ Can have severe comminution and severe soft tissue injury
  • 20. Clinical features ▪ Little swelling initially but this rapidly changes ▪ Fracture blisters are common ▪ Ankle may be deformed or dislocated
  • 21. Classification(Rudi and Allgower) ▪ Type I – Fracture involving minimal displacement ▪ Type II – Significant displacement of the joint surface ▪ Type III – Impaction and comminution of the articular surface
  • 23. Management ▪ Early management: SPAN, SCAN, PLAN. ▪ Remember Life, Limb, Fracture. ▪ Manage soft tissue swelling. ▪ Once skin has recovered, do ORIF ▪ Closed reduction w/ a cast. ▪ External fixation if needed
  • 24. 2. Ankle fractures ▪ Anatomy of the ankle ▪ Tibia and fibula form a mortise which provides a constrained articulation for the talus. ▪ Ankle stability is provided by 3 factors: ▪ Bony architecture, joint capsule and ligamentous ▪ structures: ▪ Syndesmotic ligaments ▪ Medial collateral ligaments ▪ Lateral collateral ligaments
  • 25. ▪ Stumbling and falling -Foot is usually anchored to the ground and the body lounges forward. ▪ Ankle twisting -Talus tilts or rotates forcibly in mortise causing a low energy fracture of one or both malleoli with associated injuries of the ligaments.
  • 26. ▪ Simple description: ▪ Joint can be injured on one side only (single malleolus) or on both sides (bi-malleolar fracture) ▪ Rotational injuries: ▪ 1/both sides may be injured. ▪ Posterior lip of the lower end of the tibia (posterior malleolus) may be fractured. ▪ Degree of instability depends on how much of ankle complex is damaged.
  • 28. 2. LAUGE-HANSEN CLASSIFICATION: Uses two terms: First: describes position of the foot at time of injury, second: the motion of the talus relative to the tibia Types: 1. supination – adduction 2. supination – external rotation 3. pronation – abduction 4. pronation – eversion 5. pronation – dorsiflexion Description is used because most ankle injuries are caused by the weight of the falling person applying force on the ankle with the foot in a fixed position. Classification proposes that mechanism of injury can be deduced from the X-ray appearances and that reduction involves applying the reverse movement.
  • 29. 3. Fractures of the foot ▪ Anatomy of the foot.
  • 30. Talus fracture ▪ Talus fracture is an injury of the hind foot ▪ Rare, occur due to considerable violence with axial loading or hyper dorsiflexion. ▪ Injuries include fracture of the head, neck, body, or bony processes of talus. ▪ Patients present with painful and swollen foot and ankle ▪ Obvious deformity if fracture is displaced ▪ Skin overlaying the fracture or dislocation may be tented or split
  • 32. Hawkins Classification & management ▪ Type I : non displaced fracture ▪ Type II : displaced fracture with subluxation or dislocation of the subtalar joint and a normal ankle joint ▪ Type III : displaced fracture with body of talus dislocated from both subtalar and ankle joint. ▪ Type IV: in addition to features describes in type III there is dislocation or subluxation of the head of the talus at the talonavicular joint Management ▪ Undisplaced #: Backslab until swelling has subsided followed by non-weight bearing below knee CPOP (6-8 weeks) ▪ Displaced #: closed reduction attempted first, if it fails, ORIF is performed where the reduced # is stabilised with 1 or 2 lag screws Complications -Malunion -AVN -Secondary Osteoarthritis
  • 33. Calcaneal fractures ▪ Common mechanism axial loading ▪ Calcaneum driven up against talus and is split or crushed. ▪ 10% of calcaneus #s associated with compression injuries of spine, pelvis or hip. ▪ Two types: ▪ Extra-articular #: involve calcaneal processes or posterior part of bone. Easy to manage and have good prognosis. ▪ Intra-articular #: cleave bone obliquely and run into superior articular surface. Articular facet is split apart and there may be severe comminution.
  • 34. Sanders Classification ▪ Type I: non-displaced fractures (displacement < 2 mm). ▪ Type II: consist of single intraarticular fracture dividing the calcaneus into 2 pieces. ▪ Type IIA: occurs on lateral aspect of calcaneus. ▪ Type IIB: occurs on central aspect of calcaneus. ▪ Type IIC: occurs on medial aspect of calcaneus. ▪ Type III: consist of two intraarticular fractures that divide the calcaneus into 3 pieces. ▪ Type IIIAB: two fracture lines are present, one lateral and one central. ▪ Type IIIAC: two fracture lines are present, one lateral and one medial. ▪ Type IIIBC: two fracture lines are present, one central and one medial. ▪ Type IV fractures consist of fractures with more than three intrarticular fractures.
  • 35. Presentation ▪ Foot is painful, swollen and bruised. ▪ Wider, shortened, flatter heel when viewed from behind + varus heel ▪ Tissues are thick and tender and normal concavity below the lateral malleolus is lacking. ▪ Subtalar joint cannot be moved but ankle movement is possible. ▪ Always check for signs of Compartment syndrome X-ray views ▪ Lateral, oblique and AP views ▪ Extra-articular #: fairly obvious on xray ▪ Intra-articular #: can be identified on xray, if there is displacement of fragments lateral view may show reduced of Bohler’s angle
  • 36. Management ▪ Undisplaced fractures: Closed non-surgical treatment (backslab, CPOP), use crutches for 4-6 weeks. ▪ Displaced avulsion #: ORIF, Immobilise foot in slight equinus to relieve tension on tendo Achillis. Non-weight bearing for 4-6 weeks. ▪ Displaced intra-articular #: ORIF with plates and screws. ▪ Bone grafts may be used to fill defects. ▪ Encourage exercise when pain subsides ▪ Pt allowed to use crutches 2-3 weeks after (non-weight bearing) -> Partial weight bearing only when fracture has healed -> full weight bearing only 4 weeks after that
  • 37. Complications ▪ Early: swelling and blistering, Compartment Syndrome ▪ Late: Malunion, Insufficiency of Achilles tendon (due to loss of heel height), talocalcaneal stiffness and osteoarthritis
  • 38. Lisfranc fracture ▪ Lisfranc (midfoot) injuries result if bones in the midfoot are broken or ligaments that support the midfoot are torn. ▪ Varies from minor sprains to severe fracture-dislocations ▪ m.o.i: simple twist and fall. ▪ This is a low-energy injury, commonly seen in football and soccer players. ▪ More severe injuries occur from direct trauma, such as a fall from a height. ▪ These high-energy injuries can result in multiple fractures and dislocations of the joints. ▪ It is often seen when someone stumbles over the top of a foot plantar flexed.
  • 39. Mechanism of injury Symptoms • Pain(worsened by walking) • Bruising • Swelling
  • 40. X-rays ▪ Full extent of injury hardly clear on plain x-ray; multiple vies of CT may be needed. ▪ Look out for fractures of navicular and cuneiform bones.
  • 41. Management ▪ Undisplaced sprain: cast immobilization for 4-6 weeks. ▪ Subluxation and dislocation: Traction and manipulation under anaesthesia achieves reduction. ▪ Position is then held with K-wires or screws and cast immobilization. ▪ Non-weight bearing for 6-8 weeks.
  • 42. Metatarsal fractures ▪ Due to direct blow, severe twisting injury or repetitive stress ▪ 5th metatarsal #s are usually due to forced inversion of the foot (the pot hole injury) which then causes avulsion of the base of the 5th metatarsal tuberosity ▪ Avulsion fracture occurs where a tendon attaches to the bone ▪ When an avulsion fracture occurs, the tendon pulls off a tiny fragment of bone.
  • 43. Presentation ▪ Patient often complains of having sprained the ankle ▪ Tenderness marked over area of fracture. Management ▪ Fracture usually unites readily ▪ Immobilisation in a below knee plaster for 4 weeks is advised X-rays
  • 44. Sesamoid fractures ▪ Fractures occur either due to a direct injury (i.e landing from a height on the ball of the foot), sudden traction or; ▪ chronic repetitive stress as seen in dancers and runners ▪ Patient c/o pain over the sesamoids ▪ O/E: Tender spot in the same area and pain may be exacerbated by passively hyperextending the hallux Rx:Conservative treatment ▪ Use of local lignocaine injection for pain relief ▪ In cases of marked discomfort, immobilise leg in cast 2-3 weeks
  • 45. References 1. Apley’s consice system of orthopaedics and fractures 2. Toronto notes 2016 3. Orthopaedics and fractures lecture notes(4th ed.), wiley-Blackwell.