Lower limb fractures

49 Lower limb fractures





Questions



image What is the mechanism of femoral shaft fractures?

image What is the most common direction of hip dislocation?

image How are tibial shaft fractures managed?

Fractures of the lower limb are common. Fractures of the neck of femur are extremely common and because of its importance and prevalence, it has a dedicated chapter (50).




Femoral shaft fracture


Femoral shaft fractures most commonly occur in young people as a result of high-energy impacts (e.g. road traffic accidents (RTA; Fig. 3.49.1)), but they may also occur in those with oesteoporosis. The risk of complications is high: shock (a femoral fracture results in blood loss of 1–2 litres, and the femoral artery may be damaged), fat embolus, thromboembolism and infection. Treatment is commonly surgical with an intramedullary nail, where screws can be passed through the bone and nail to prevent rotation (a locking nail). Traction, cast bracing and external fixation are also sometimes used.


image

Fig. 3.49.1 Road traffic accidents often lead to traumatic hip dislocation and an associated femoral shaft fracture.



Hip dislocation


The majority of hip dislocations are posterior and follow impact directed along the femoral shaft, commonly during a RTA when the knee strikes the dashboard and the femoral head is forced backwards. Associated femoral and acetabular fractures should be sought. The leg is shortened, adducted, internally rotated and in slight hip flexion. The femoral head may be palpable in the buttock, and the sciatic nerve may become damaged. The femoral head is reduced under general anaesthesia as soon as possible, and held in traction for 3 weeks; an associated acetabular fracture requires ORIF.



Around the knee


Intra-articular joint involvement is common in knee trauma, and any disruption in the joint line must be accurately reduced to prevent post-traumatic osteoarthritis. The fractures around the knee can be divided into supracondylar, femoral condyle, patellar and tibial plateau fractures. The last range from simple to very complicated (Fig. 3.49.2), involving both the tibia and femur; there are often depressed, crushed and cleaved off segments, which must be accurately elevated and fixed into position to ensure a good joint line.


image

Fig. 3.49.2 Tibial plateau fractures are classified by the Schatzker system.

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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Lower limb fractures

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