Surgery CBL4: Lower Limb Fractures

Assessment of an Injured Limb

follow ATLS guidelines neurovascular assessment photos of wounds (close + far) reduction of displaced fractures open reduction is surgical while closed involves manipulation stabilise fracture back slab: cheap but not stable. First aid use POP: cheap + >more supportive but only stable fractures splint: same as ^ traction: non invasive but long bed rest required K wires: useful in good quality bone e.g. wrist external fixation: complex fractures/soft tissue compromise plates: used when precise reduction is required e.g. joint IM nails: for patho fractures however can compromise injured lungs arthroplasty reassess neurovasc radiographs PAIN RELIEF!

Hip Fractures

method of fixation depends on blood supply compromise   BLOOD SUPPLY TO FEMORAL HEAD medial circumflex terminal branches from medullary a. lateral circumflex FA Artery of ligamentum teres

INTRACAPSULAR HIP FRACTURES if undisplaced blood supply assumed to be uninjured and fracture just needs to be fixed with 3 screws (usually cannulated if blood supply is good) if displaced then blood supply interrupted leading to avascular necrosis so head needs to be removed and replaced (except in young people) hemi-arthroplasty for less mobile elderly patients and a full arthroplasty for active patients try to preserve own hip in young patients with screws as prosthetics do not last INTER-TROCHANTERIC FRACTURES: dynamic hip screw: controlled collapse of fracture until it stabilises FRACTURES DOWN FEMUR: IM device FEMORAL SHAFT FRACTURES: usually IM nails although can use external fixation, plating or traction  

OTHER FRACTURES

INTRA-ARTICULAR KNEE FRACTURES: to restore joint surface usually open reduction and internal fixation with plates and screws is usually employed TIBIAL SHAFT FRACTURES: POP is an excellent option if the fracture is suitable External fixation for complex injuries/soft tissue compromise Plating is rarely used for shaft # ANKLE FRACTURES: serious risk of talar shift where talus fails to sit in the middle of tibia and fibula which may cause post traumatic arthritis. stable injuries: POP unstable injuries: open reduction and internal fixation