Lower Limb Fractures
PROXIMAL FEMUR
KNEE
PATELLA
TIBIAL PLATEAU
TIBIAL SHAFT
FIBULA
STRESS #
ANKLE
FOOT
METATARSALS
Source
Dr Roger Butorac
- Most NOF will need surgery, unless undisplaced or impacted
- Lesser trochanter (hurdling) #
- Treated conservatively
- Shaft
- Surgery
KNEE
- Ligament sprain or rupture can appear like bony lesions
- Segond # (avulsion # from anterolateral aspect of prox tibia --> ACL rupture)
- Need not treat # but need to treat ACL rupture
- Pellegrini-Stieda lesion (related to old MCL sprain)
- Avulsion of tibial insertion of ACL, PCL
- Surgery
PATELLA
- Direct blow --> Stellate or undisplaced # with extensor mechanism intact (continuity b/in quadriceps mm and patella tendon)
- Treat conservatively
- Aspiration of haemarthrosis and splint knee in extension 3-4w
- Indirect blow --> traction force, fragmented and retinaculae torn
- Surgery
- Dislocation. May result in osteochondral fragments w/in knee joint
- Simple: reduce by passive extension and medial force to patella
TIBIAL PLATEAU
- Bumper # (varus/valgus force with axial loading)
- Undisplaced: Conservative --> Aspirate haemarthrosis --> support in hinged knee brace
- Severe: ORIF
TIBIAL SHAFT
- Twisting --> spiral #
- Angulatory --> transverse/ short oblique #
- Undisplaced: Long leg cast (twist)/ Sarmiento cast (transverse). Cover joint above and below.
FIBULA
- Isolated fib # rare - check ankle
- Maisonneuve # prox fibula by rotation injury @ ankle
- Conservative. Look for fibular nerve involvement
STRESS #
- Most common: prox tib or distal fib
- Conservative. Rest
ANKLE
- Usually twisting and/or tiliting forces
- Conservative. At least 3 planes of X ray
FOOT
- Talar # --> large force, osteochondral talar dome --> sprain
- Undisplaced: Cast
- Calcaneum
- Conservative. RICE
METATARSALS
- Jones # (5th metatarsal)
- Surg
Source
Dr Roger Butorac