Lower limb fracture

1. LOWER LIMB FRACTURES

2. ❖Femur
❖Tibia and Fibula
❖Patella
❖Ankle
❖Calcaneal
❖Metatarsals
LOWER LIMB
FRACTURES

3. FEMORAL FRACTURES
• Proximal end
• Shaft
• Distal end

4. PROXIMAL
END
▪ Intracapsular
▪ Capital : Fracture of the head
▪ Subcapital :below the femoral head
▪ Transcervical :across the mid-femoral neck
▪ Basicervical :across the base of the femoral neck.
▪ These injuries (last three)may be correctly termed
fractures of the 'neck of femur' (NOF).

5. ▪ Extra Capsular
▪ Intertrochanteric
▪ Subtrochanteric
Shaft
▪
▪ Distal end
▪ Supracondylar
▪ Condylar

7. Intracapsular fracture – Subcapital

8. Intertrochanteric fracture

9. Subtrochanteric fracture

10. THE GARDEN CLASSIFICATION OF
FEMORAL
NECK FRACTURES
▪ Based on the degree of displacement on the anteroposterior
radiographs.
Differentiation has therapeutic as well as prognostic value.
▪
▪ Type I and II fractures have a low incidence of avscular
necrosis .

11. GRADI
NG
Grade 1: incomplete impacted fracture of the femoral neck.
Grade 2: complete undisplaced fracture.
Grade 3: complete fracture with moderate displacement.
▪
▪
▪
▪ Grade 4: severely displaced fracture.

12. PAUWELS
CLASSIFICATION
▪ Pauwels classification refers to the angle the fracture line
makes with the horizontal

13. Grade 1 Grade 2 Grade 3

14. GARDEN…
.?
Grade 1

15. GARDEN…
?
Grade 4

16. FEMORAL SHAFT FRACTURES
▪ Femoral fractures require high force trauma
▪ Pathological fractures in old osteoporotic
▪ AP and lateral views

17. Spiral fracture with posterior angulation, lateral
displacement and shortening

18. Pathological femoral shaft fracture
Transverse fracture with rotational displacement and shortening

19. FRACTURES OF LOWER END OF
FEMUR
▪ Extra-articular or supracondylar in which the fracture does
not extend to the knee joint line.

21. PARTIAL-ARTICULAR /
CONDYLAR
The fracture extends to the knee joint line but part of the
condyles remain attached to the femur shaft.

23. COMPLETE-ARTICULAR OR
INTERCONDYLAR
The fracture extends to the knee joint line but the
condyles are completely separated from the femur
shaft.

25. SUPRACONDYLAR
FRACTURES
• The lower fragment is drawn backward by the gastrocnemius and plantaris, and
the popliteal vessels and internal popliteal nerve may either be wounded or
stretched over its sharp upper edge. The artery lying deepest is the most liable
to injury, then the vein, and finally the nerve.

27. Supracondylar fracture

28. Fracture medial condyle

29. Bipartite patella

30. Patellar fracture- haemarthrosis

31. ❖Tibial plateau fracture
❖Stress fractures
❖Toddlers fracture

32. TIBIAL PLATEAU
FRACTURES
▪ Fractures of the tibial plateau can be subtle or wide
displacement with varying degrees of comminution.
▪ There may be depression of the plateau surface,
displacement of a fracture fragment or both.
▪ Lipohaemarthrosis.

33. Lateral tibial plateau fracture
The fracture fragment is displaced and depressed from its normal
position

34. Depressed tibial plateau contour- Lipohaemarthrosis

35. Tibial and fibular fracture

36. Tibial stress fracture

37. Toddler's fracture
Fine spiral line through the tibial shaft

38. ANKLE FRACTURES
Lateral malleolar fractures
▪ Lateral malleolar fractures are categorized according to their
position in relation to the distal tibiofibular syndesmosis at
the level of the ankle joint.

39. WEBER FRACTURE
CLASSIFICATION
Weber A = Distal to ankle joint
Weber B = At level of ankle joint
▪
▪
▪ Weber C = Proximal to ankle joint

40. Lateral malleolus fracture(Weber A)

42. FINDINGS &
WEBER…?
Bimalleolar fracture (Weber B)

43. Trimalleolar fracture

44. OSTEOCHONDRAL
FRACTURES
Occasionally ankle trauma causes a fracture of the
talus bone surface. These 'osteochondral' injuries are
often subtle and so this area should be assessed
carefully on all post-traumatic ankle X-rays.

45. Osteochondral fracture
Loss of the normal talar dome cortex contour due to an osteochondral
fracture

46. CALCANEAL
FRACTURES
• Falling from height can lead to severe calcaneal fractures, which may be
accompanied by axial loading fractures of the spine.
▪
▪ Calcaneal fractures due to a fall from height are often
comminuted and intra-articular.

47. BOHLER’S
ANGLE
▪ A line is drawn from the tuberosity to the most superior part
of the posterior facet.
▪ Another line is drawn from the most superior part of the
facet to the anterior process.
Normally the angle created is between 20 and 40 degrees.
▪
▪ If the angle is less than 20 degrees, this indicates depressed
fracture.

48. BOHLER’S
ANGLE

49. THE CRITICAL ANGLE OF
GISSANE
• It is formed by a line along the lateral margin of the posterior facet and another
line extending anterior to the beak of the calcaneus. The normal value is 95 to
105 degrees with an increase representing posterior facet collapse

51. TYPES OF CALCANEAL
FRACTURES
• Intra and Extrarticular fractures on the basis of subtalar joint involvement.
▪ Intrarticular fractures are more common and involve the
posterior talar articular facet of the calcaneus.
▪ Extrarticular fractures are less common, and located
anywhere outside the subtalar joint.

52. THE SANDERS SYSTEM
CLASSIFICATION
Is the most commonly used system for categorizing
intrarticular fractures.
Classifies these fractures into four types, based on the location
of the fracture at the posterior articular surface.

53. TYPES
▪ Type I fractures are non-displaced fractures (displacement <
2 mm).
▪ Type II fractures consist of a single intrarticular fracture that
divides the calcaneus into 2 pieces.
▪ Type III fractures consist of two intrarticular fractures that
divide the calcaneus into 3 articular pieces.
▪ Type IV fractures consist of fractures with more than three
intrarticular fractures.

55. METATARSAL
FRACTURES
▪
▪
▪
Oblique fracture of 5thmetatarsal shaft
5TH Metatarsal base fracture
Metatarsal stress fractures
Stress fractures of the metatarsals are common in athletically
active individuals. These may not be visible on initial X-rays
but follow up images show periosteal stress reaction. This
has the appearance of fusiform bone expansion.

57. NORMAL UNFUSED 5TH METATARSAL bone apophysis is
aligned more longitudinally along the bone