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DISCUSSION

TIBIA AND FEMUR SHAFT FRACTURE

INTRODUCTION
Fracture a break in the structural continuity of
bone, cartilage, joint and growth plate
If overlying skin remains intact : Closed
fractured
If skin not intact : Open Fractured

Nalyagam S. Principles of Fractures. In: Solomon L. Apleys System of Orthopaedics and Fractures Ninth edition. 2010

Anatomy
Largest
tubular
bone in the body
and is surrounded
by the largest
mass of muscle.
The
important
feature of femoral
shaft
is
its
anterior bow.
Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2010

Anatomy

ANTERIOR
COMPARTMENT

Quadriceps :
vastus lateralis,
vastus intermedius,
vastus medius,
rectus femoris

Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2010

Anatomy

POSTERIOR
COMPARTMENT

contain three
large muscle
termed the
hamstring
Biceps Femoralis,
Semitendinous,
Semimembranou
s.
Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2010

Anatomy
MEDIAL COMPARTMENT

Gracilis
Adductor longus
Adductor brevis
Adductor magnus

Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2010

Anatomy
The tibia is a long
tubular bone with a
triangular cross
section.
It has a
subcutaneous
anteromedial border
and is bounded by
four tight fascial
compartments
(anterior, lateral,
superficial posterior,
Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2010

Anatomy
The tibia is a long
tubular bone with a
triangular cross
section.
It has a
subcutaneous
anteromedial border
and is bounded by
four tight fascial
compartments
(anterior, lateral,
superficial posterior,
Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2010

Anatomy

ANTERIOR
COMPARTMENT

Tibialis anterior
Extensor hallucis
longus
Extensor
digitorum longus
Peroneus tertius

Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2010

Anatomy
LATERAL COMPARTMENT

Peroneus longus
Peroneus brevis

Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2010

Anatomy
SUPERFICIAL POSTERIOR
COMPARTMENT

M. Gastrocnemius
M. Soleus
M. Plantaris

Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2010

Anatomy
DEEP POSTERIOR
COMPARTMENT

M. Posterior
tibialis
M. Flexor hallucis
longus
M. Flexor
digitorum longus
M. Popliteus

Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2010

MECHANISM OF INJURY
Mechanism of
injury

Direct trauma

Indirect trauma

Energy of injury

High-energy
injuries

Low energy
injuries

Examples

Motor vehicle
accident

Torsional
(Fall and twisting)

Common Age

children and
adolescents

younger child

Heinrich SD, Rockwood and Wilkins' Fractures in Children, 4th p. 1033

Classification
Femoral Shaft Fracture
Winquist and Hansen

Type 1

Type 1 there is only a tiny


.cortical fragment
Type 2 the butterfly fragment
is larger but there is still at
least 50 per cent cortical
contact between the main
. fragments
Type 3 the butterfly fragment
involves more than 50 per cent
.of the bone width
Type 4 is essentially a
.segmental fracture

Heinrich SD, Rockwood and Wilkins' Fractures in Children, 4th p. 1033

Type 2

Type 3

Type 4

CONFIGURATION CLASSIFICATION
OF SHAFT TIBIA

Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2010

HOW TO DIAGNOSES ?
Chief complain,
Mechanism of
trauma, History
of prior
treatment

1. Look
2. Feel
3. Move
4. NVD
(Pain, Swelling,
Deformity)
views
joints
limbs
injuries
occasions

4
3
2
L
P
a
h
b
1
Xo
y
-H
rs
Ria
1. Two
as
tc
2. Two
a
yto
o
3. Two
rl
(r
y
4. Two
ry
E
ux
5. Two
E
lT
a
x
ea
m Solomon. L. et al. Apleys System of Orthopedics and Fractures 9 Edition. New York : Arnold. 2010
a
th

PATIENT EVALUATION
Closed fracture 1/3
middle left femur
Closed fracture 1/3
middle right fibula

Radiological
Examination

Physical
Transverse Fracture
Examination
1/3 middle left
History
Pain since 7
hours ago
- Feel down due
to traffic
accident
- History of prior
treatment
with casting
-

- Deformity
- Swelling
- Tenderness

femur
Transverse Fracture
1/3 middle right tibia

Solomon. L. et al. Apleys System of Orthopedics and Fractures 9th Edition. New York : Arnold. 2010

Goals of fracture management


Recognize

Fracture site, types of fracture

Reduction

For adequate apposition and normal allignment of bone

Retain

Maintain the reduction

Rehabilitation
Restore function
Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.

Treatment

CONSERVATIV
E

OPERATIVE

Indication :
- Fail Conservative
- Open fracture grade III (grossly
contaminate, associated vascular
injury)
- Fracture associated with
compartement
syndrome
- For traction (avulsion) fractures
Circular
in which fragment are held apart
Casting
- Fractures associated with
compartment syndrome
-Severely comminuted fractures
- Associated femoral fracture (floating
knee)
Internal Fixation
- Fractures in patients with spasticity
External Fixation
syndromes (cerebral palsy, head
injury)
fractures in which adequate
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of-unstable
Fractures, 4th Edition.

Indication :
- Closed fracture
- Open fracture grade
I-II
- Minimal Displaced

Treatment
Conservative

Operative

Analgetic

Debridement

Traction

External fixation

Close reduction +
cast immobilization

Intramedullary nailing
Plate and screws

Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.

Complication
Early

Compartement syndrome
Fat embolism .
Shock .
Infection .
Thromboembolism .

Late

Delayed union
Non-union .
Malunion .
Joint stiffness .
Refracture and implant failure .
Shortening of limb .

Solomon, L, Warwick D.L, Nayagam,S. Apleys system of orthopedic and fractures. 8th editions. 2008. p695-9

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