FEMUR, KNEE, PATELLA AND TIBIAL PLATEAU FRACTURES

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FEMUR, KNEE, PATELLA AND TIBIAL PLATEAU FRACTURES
Orthopaedics Department

• H. Sithebe

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FEMUR FRACTURES

• Femur Head
• Femur Neck
• Intertrochanteric
• Subtrochanteric
• Shaft
• Supracondylar
• Condylar

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FEMUR NECK FRACTURES

• CAUSES
• CLINICAL PRESENTATION
• CLASSIFICATION
• MANAGEMENT

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FEMUR NECK FRACTURES

• Common-Elderly patients, Caucasians, women , Ass
  medical conditions
• CLASSIFICATION-Garden- Dis /Undisplaced
• -Intra/ extra
  capsular

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GARDEN CLASSIFICATION
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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

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FEMUR INTERTROCAHNTERIC S
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FEMUR INTERTROCAHNTERIC S

• Risk Factors-
• Osteoporosis, medical co morbidities , positive
  maternal history
• Classification
• Stable / Unstable
• Stable- 2 part, sustains medial compressive
  forces
• Unstable- 3 part, Falls into Varus, cannot
  sustain
• -Reverse oblique

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FEMUR INTERTROCAHNTERIC S

• MANAGEMENT
• Resuscitate patient
• Consult Physicians and Anaesthetist
• Planned surgery within 4 days
• DHS, Cephalo medullary Device- choose according
  to pattern

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FEMUR INTERTROCAHNTERIC S

• Early-mentioned before
• Late -Implant failure, Infection ,
• -Mortality , Leg length discrepancy

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SUBTROCHANTERIC FRACTURES

• Causes- High E transfer Young Pts
• Anatomically- 5cm below the lesser trochanter
• Forces acting- PICTURE

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SUBTROCHANTERIC FRACTURES

• MANAGEMENT-ABC
• ORIF
• Complications- Non Union Watershed area
• -Mal Union same

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FEMUR SHAFT

• CAUSES-High E Trauma
• CLINICAL PRESENTATION
• -Isolated/ Poly Trauma
• Leg shortened external rotation
• Pain etc
• CLASSIFICATION-Pattern of Fracture

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FEMUR SHAFT

• MANAGEMENT
• ABC
• Prevent possible complications eg Fat embolism Sx
• Exclude ass s-3 neck - 30 missed
• Exclude ass Knee Injuries- 10 LIGAMENT Injuries
• IM Nail ORIF

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FEMUR DISTAL

• CAUSES-Same
• CLINICAL PRESENTATION-Swelling, Pain etc
• 
  -NB! Vascular injury
• CLASSIFICATION
• Supracondylar (Extra-articular )
• Intercondylar(Intra-articular )

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FEMUR DISTAL

• MANAGEMENT
• ABC
• Exlude Popliteal Art Injury
• ORIF
• Early Knee ROM

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PATELLA FRACTURES

• CAUSES- Direct or avulsion
• CLINICAL PRESENTATION
• Same all trauma
• Specific- Inability to extend the Knee
• Evaluate the Iliotibial tract and Patella
  Retinaculum
• Old- tendon intra substance tear
• Young-Avulsion injuries

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PATELLA FRACTURES

• CLASSIFICATION
• Transverse
• Vertical
• Comminuted
• MANAGEMENT
• Displaced -2mm step, 3mm apart-ORIF
• Undisplaced-Ranger Brace 6 weeks

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TIBIA FRACTURES PROXIMAL

• CAUSES- High E Transfer
• -Axial loading with either
  Varus
• - or Valgus stress
• CLINICAL PRESENTATION
• -Same Trauma
• -Specific evaluate Vascular Injury
• - ass ligament injuries

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TIBIA FRACTURES PROXIMAL

• CLASSIFICATION- Schatzker Classification

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TIBIA FRACTURES PROXIMAL

• MANAGEMENT
• ABC
• Evaluate axial skeleton
• Stabilise
• Definitive-ORIF

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QUESTIONS

• THANK YOU