Orthopaedics Department FEMUR KNEE PATELLA AND TIBIAL PLATEAU
Orthopaedics Department FEMUR, KNEE, PATELLA AND TIBIAL PLATEAU FRACTURES H. Sithebe 1
FEMUR FRACTURES Femur Head Femur Neck Intertrochanteric Subtrochanteric Shaft Supracondylar Condylar 2
FEMUR NECK FRACTURES CAUSES CLINICAL PRESENTATION CLASSIFICATION MANAGEMENT 3
FEMUR NECK FRACTURES Common-Elderly patients, Caucasians, women , Ass medical conditions CLASSIFICATION-Garden- Dis /Undisplaced -Intra/ extra capsular 4
GARDEN CLASSIFICATION 5
FEMUR NECK FRACTURES Displaced – young patient- ORIF -Older patient- Arthroplasty Undisplaced- ORIF Complications - AVN - young Cx Elderly-Confusion, Electrolyte imbalances, UTI , Pneumonia, pressure sore etc Q-within 4 days 6
FEMUR INTERTROCAHNTERIC #”S 7
FEMUR INTERTROCAHNTERIC #”S Risk Factorsv. Osteoporosis, medical co morbidities , positive maternal history Classification – v. Stable / Unstable q. Stable- 2 part, sustains medial compressive forces q. Unstable- 3 part, Falls into Varus, cannot sustain -Reverse oblique 8
FEMUR INTERTROCAHNTERIC #”S MANAGEMENT v. Resuscitate patient v. Consult Physicians and Anaesthetist v. Planned surgery within 4 days § DHS, Cephalo medullary Device- choose according to # pattern 9
FEMUR INTERTROCAHNTERIC #”S Early-mentioned before Late -Implant failure, Infection , -Mortality , Leg length discrepancy 10
SUBTROCHANTERIC FRACTURES Causes- High E transfer –Young Pts Anatomically- 5 cm below the lesser trochanter Forces acting- PICTURE 11
SUBTROCHANTERIC FRACTURES MANAGEMENT-ABC ORIF Complications- Non Union –Watershed area -Mal Union & same 12
FEMUR SHAFT q. CAUSES-High E Trauma q. CLINICAL PRESENTATION -Isolated/ Poly Trauma Leg shortened external rotation Pain etc q CLASSIFICATION-Pattern of Fracture 13
FEMUR SHAFT MANAGEMENT v. ABC v. Prevent possible complications eg Fat embolism Sx v. Exclude ass #”s-3% neck #- 30% missed v. Exclude ass Knee Injuries- 10% LIGAMENT Injuries v. IM Nail= ORIF 14
FEMUR DISTAL CAUSES-Same CLINICAL PRESENTATION-Swelling, Pain etc -NB! –Vascular injury CLASSIFICATION v. Supracondylar (Extra-articular ) v. Intercondylar(Intra-articular ) 15
FEMUR DISTAL MANAGEMENT v. ABC v. Exlude Popliteal Art Injury v. ORIF v. Early Knee ROM 16
PATELLA FRACTURES CAUSES- Direct or avulsion CLINICAL PRESENTATION v. Same all trauma v. Specific- Inability to extend the Knee v. Evaluate the Iliotibial tract and Patella Retinaculum v. Old- tendon intra substance tear v. Young-Avulsion injuries 17
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PATELLA FRACTURES CLASSIFICATION q. Transverse q. Vertical q. Comminuted MANAGEMENT v. Displaced -2 mm step, 3 mm apart-ORIF v. Undisplaced-Ranger Brace 6 weeks 19
TIBIA FRACTURES PROXIMAL CAUSES- High E Transfer -Axial loading with either Varus - or Valgus stress CLINICAL PRESENTATION v-Same Trauma v-Specific evaluate Vascular Injury v- ass ligament injuries 20
TIBIA FRACTURES PROXIMAL CLASSIFICATION- Schatzker Classification 21
TIBIA FRACTURES PROXIMAL MANAGEMENT v. ABC v. Evaluate axial skeleton v. Stabilise v. Definitive-ORIF 22
QUESTIONS THANK YOU 23
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