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lower limb fractures &

Dislocations
DR. Khalid Bakarman
Pediatric & trauma orthopedic
consultant
Topics
• Ace tabular fractures.
• Pelvic Fractures.
• Hip Dislocations.
• Proximal femoral fracture.
• Femoral Shaft Fractures.
• Fracture tibial plateau.
• Tibial shaft Fractures.
• Ankle fractures.
Mechanism of fractures
• Lower limb fracture is a result of a high
energy trauma except in elderly people or
diseased bones
• Types of fracture are depend on position of
limb during impaction and magnitude of
forces applied.
Management
• The proper way to treat a patient with high
energy trauma is to look at the patient as
whole ,not to injured limb alone!
• So the aim to treat such patient is to save life
first, then save limb ,finally to save function.
• A.B.C.D
Pelvic Fractures
• Pelvic fracture is a high energy trauma , as a
result of MVA, fall .
• Classifications. ( Tile)
Type A. Stable
A 1. fractures of the pelvic not involving the
Ring.
A 2 . Stable , minimally displaced fracture of
the Ring .
• Type B. Rotationally Unstable ,Vertically
Stable.
B1. Open Book

B2 . Lateral Compression : Ipsilateral

B3. Lateral Compression :Contra lateral


• Type C. Rotationally and Vertically Unstable

C1 . Unilateral

C2 . Bilateral

C3 . Associated with Acetabular Fracture


MANEGEMENT
• Aggressive treatment .

• Obtain X-Ray: AP pelvic, Inlet ,outlet ,Ct Scan.


Treatment
• Aggressive treatment . By A.B.C.D.
• Obtain X-Ray: AP pelvic, Inlet ,outlet
• Ct Scan.
• Think in systemic approach.
• Specific treatment:
type A . symptomatic treatment
type B .ORIF with plates& screws ,External Fix.
Type C . ORIF with plates & screws. Both AP.
Emergency treatment
Protect primary blood clot by early pelvic splintage and
prevention of exessive movement

IV fluids, early blood transfusion, early fresh frozen


plasma, platelets, cryoprecipitate

Prevent hypothermia and acidosis

Stop other bleeding sites

Stabilize pelvis
complications
A. Hemorrhage – life threatening
B. Bladder/bowel injuries
C. Neurological damage
D. Obstetrical difficulties
E. Persistent Sacro-iliac joint pain
F. Post –traumatic arthritis of the hip with
acetabular fractures
Acetabular fracture
• Usually it is a result of high- energy trauma .
• The acetabulum is divided into four
segments—an anterior column and wall (rim)
and a posterior column and wall (rim). .
Fractures of the acetabulum are classified
based on their involvement of these
structures .
classification Letournel and Judet
Investigation
• AP pelvis.
• Judat views ( Internal Oblique,Obturator view)
• C T scan .
TREATMENT

• Indications for Nonoperative Treatment

1. Nondisplaced and Minimally Displaced


Fractures.
2. Fractures with Significant Displacement but in
Which the Region of the Joint Involved Is Judged
To Be Unimportant Prognostically

• 3.Secondary Congruence in Displaced Both-


Column Fractures
• Medical Contraindications to Surgery
• Local Soft Tissue Problems, Such as Infection,
Wounds, and Soft Tissue Lesions from Blunt
Trauma.
• Elderly Patients with Osteoporotic Bone in
Whom Open Reduction May Not Be Feasible.
• skeletal traction for 4-6 weeks. And then start
physiotherapy in bed , PWP ,FWBAT.
Operative Treatment
• Indications for Operative Treatment.
1. An acetabular fracture with 2 mm or more
displacement in the dome of the acetabulum.
2. any subluxation of the femoral head from a
displaced acetabular fracture noted on any of
the three standard roentgen graphic views
• More than 50% involvement of the articular
surface of the posterior wall or clinical
instability with hip flexion to 90 degrees in
posterior wall fractures .
• Incarcerated Fragments in the Acetabulum
after Closed Reduction of a Hip Dislocation.
complications
• posttraumatic arthritis in 17%.
• a vascular necrosis after posterior dislocation
was 7.5%.
• Infections are reported to occur in 1% to 5%
• Sciatic nerve palsies as a result of the initial
injury occur in approximately 10% to 15%.
• Heterotopic ossification (HO) occurs after
most extensile approaches
HIP Dislocations
Complication
• post traumatic arthritis
• Femoral head injury with risk of AVN (100% if
the dislocation last >12 H)
• Sciatic nerve palsy 25% ( 10 % permanent)
• Femoral shaft /neck fracture
• knee injury
Treatment
neck of femur
• Nondisplaced fracture of neck of femur can
be treat with canulated screws.
• Displaced fracture ----------DHS in patient less
than 60 years.
• > than 65 years look for.
. Level of activities.
. Status of the acetabulum.
then chose THR vs hemi arthoplasty.
Treatment
• Intertrochantaric fracture-------DHS . DCP.
• Subtrochantaric fracture---------DHS.ABP.DCP.
• Combination of both------- IM Nail with
Canulated srews.