下肢骨折
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• Classification according to fracture intra-or extra-capcular
• Classification according to Pauwell’s angle
Neck of Femur fractures
Intracapsular
Extracapsular
•Proximal (5 cm below lesser trochanter = Subtrochanteric)
Site Shape Displacement
•Mid shaft
•Distal ( 9cm above knee joint = Supracondylar) Transverse Oblique Spiral Multifragmentary(comminut ed)Butterfly segment Segmental Translation
Undisplaced
Displaced
Trochanteric
Subtrochanteric
Stable
Unstable
Transtrochanteric
Classification according to fracture line
Intra
Intra-capsular
Extra-capsular
• Femoral neck factures in young adults are generally associated with highenergy trauma such as motor vehicle accidents
Mechanism of injury
• In general , mechanism of injury is described as a indirect blow, often associated with forced external rotation of the extremity
• Shorting and external rotation of the leg, usually external rotation degree 40°~60°
The typical deformity
Diagnosis
• History
• Physical examination • Radiographs
multiple pins
Dynamic screw and plate
Complications
1. AVN(avascular necrosis) • undisplaced fracture ~ 10%
displaced fracture up to ~ 80% either partial or complete (variable reporting)
coxa vara.
The femoral anterersion angle
Epidemiology
1. increased freq with
age dementia malignancy chronic illness, osteoporosis
2. decreased freq with
Lower Extremity Fracture
1st hospital of Xinjiang Medical University
Fracture of proximal part of femur
Anatomy review
Blood supply
4 groups 1. Extracapsular arterial ring 2. Ascending cervical branches 3. Subsynovial intracapsular ring ( Chung) 4. Artery of the lig teres
The Garden classification (GradeⅠ)
• Valgus impaction of the femoral head
The Garden classification (GradeⅡ)
• Complete but nondisplaced
The Garden classification (GradeⅢ)
Classification
• There are several classification schemes for femoral neck fractures
• The most commonly used classification is that proposed by Garden
Classification according to Pauwells’ angle
• Pauwells’ angle >50º is adduction fracture, which is a more vertical and unstable fracture that produces a high risk of union
long term physical activity supplemental Vit D3 and Cain elderly women HRT
Causes
• The majority of femoral neck fractures are the result of lowenergy trauma such as a simple fall in the elder population
• Varus displacement of the Байду номын сангаасemoral head
The Garden classification (GradeⅣ)
• Complete loss of continuity between both fragments
Other classification schemes
The principles of therapy
• based on pt age and grade of fracture
1. Pt less than 65 and do not have a chronic illness, poor life expectancy ORIF 2. Pt between 65 and 75 those with high functional demand those with low demand , chronic illness arthroplasty 3. Pt more than 75 arthroplasty ORIF
• DVT/PE (deep vein thrombosis)
DVT ~ 40% low dose warfarin in pts who justify risk of anticoagulation
Nonunion
Fracture of Femoral shaft
Anatomy review
Distal 1/3 rd fracture
A.poplitea and V.poplitea
M.beceps femoris
M.gastrocnemii
Winquist 1980 classification
Coronal Section
Bony structure
AP Hip Lateral Hip
The neck shaft angle
When it is >127º ,
collum valgum .
The normal neck shaft angle is 127º .
When it is <127º ,
The Garden classification
• This classification is based on the degree of displacement shown on the anteroposterior (AP)radiograph • The Garden classification is of prognostic value for the incidence of avascular necrosis, the higher the Garden number, the higher the incidence
Methods of treatment
• Internal fixation 1, multiple pins 2, crossed screw-nails 3, compression with dynamic screw and plate • Arthroplasty AMP for pts more than 70 THR for pts less than 70
Differential diagnoses
• The intertrochanteric fracture 1, very unstable 2, mal-union is almost inevitable unless they are fixed internally 3, usually external rotation degree>90° • The intertrochanteric dislocation
Classification according to Pauwells’ angle
•Pauwells’ angle <30º is abduction fracture, which is a horizontal and stable fracture that has the lowest risk of nonunion
3. Distal 1/3 rd fracture
proximal 1/3rd fracture
M.gluteus medius M.iliopsoas
M. adductor
Middle 1/3 rd fracture
M.iliopsoas M.gluteus medius
M. adductor
• late segmental collapse occurs in
~ 10% undisplaced fracture ~ 30% displaced fracture
2. Failure of fixation • Nonunion
rare in undisplaced fracture ~ 30% in displaced fracture treat with either a valgus osteotomy or an arthroplasty
Posterior View • Popliteal artery and vein • Sciatic Nerve
Causes
• usually high energy trauma
Classification
• by location, fracture pattern, comminution, soft tissue injury, mechanism
Neck of Femur fractures
Pipkin Fracture
• Fracture of femoral head in association with posterior dislocation of hip
The clinical presentations
• Pain on stressing the hip joint • Swelling and bruising around the fracture • Impaired function • Displaced fracture at the upper end of the femur
Shortening Angulation
Rotation
Descriptive animation
Typical displacement realitive to the different location of the fracture
1.proximal 1/3rd fracture 2. Middle 1/3 rd fracture
• Classification according to Pauwell’s angle
Neck of Femur fractures
Intracapsular
Extracapsular
•Proximal (5 cm below lesser trochanter = Subtrochanteric)
Site Shape Displacement
•Mid shaft
•Distal ( 9cm above knee joint = Supracondylar) Transverse Oblique Spiral Multifragmentary(comminut ed)Butterfly segment Segmental Translation
Undisplaced
Displaced
Trochanteric
Subtrochanteric
Stable
Unstable
Transtrochanteric
Classification according to fracture line
Intra
Intra-capsular
Extra-capsular
• Femoral neck factures in young adults are generally associated with highenergy trauma such as motor vehicle accidents
Mechanism of injury
• In general , mechanism of injury is described as a indirect blow, often associated with forced external rotation of the extremity
• Shorting and external rotation of the leg, usually external rotation degree 40°~60°
The typical deformity
Diagnosis
• History
• Physical examination • Radiographs
multiple pins
Dynamic screw and plate
Complications
1. AVN(avascular necrosis) • undisplaced fracture ~ 10%
displaced fracture up to ~ 80% either partial or complete (variable reporting)
coxa vara.
The femoral anterersion angle
Epidemiology
1. increased freq with
age dementia malignancy chronic illness, osteoporosis
2. decreased freq with
Lower Extremity Fracture
1st hospital of Xinjiang Medical University
Fracture of proximal part of femur
Anatomy review
Blood supply
4 groups 1. Extracapsular arterial ring 2. Ascending cervical branches 3. Subsynovial intracapsular ring ( Chung) 4. Artery of the lig teres
The Garden classification (GradeⅠ)
• Valgus impaction of the femoral head
The Garden classification (GradeⅡ)
• Complete but nondisplaced
The Garden classification (GradeⅢ)
Classification
• There are several classification schemes for femoral neck fractures
• The most commonly used classification is that proposed by Garden
Classification according to Pauwells’ angle
• Pauwells’ angle >50º is adduction fracture, which is a more vertical and unstable fracture that produces a high risk of union
long term physical activity supplemental Vit D3 and Cain elderly women HRT
Causes
• The majority of femoral neck fractures are the result of lowenergy trauma such as a simple fall in the elder population
• Varus displacement of the Байду номын сангаасemoral head
The Garden classification (GradeⅣ)
• Complete loss of continuity between both fragments
Other classification schemes
The principles of therapy
• based on pt age and grade of fracture
1. Pt less than 65 and do not have a chronic illness, poor life expectancy ORIF 2. Pt between 65 and 75 those with high functional demand those with low demand , chronic illness arthroplasty 3. Pt more than 75 arthroplasty ORIF
• DVT/PE (deep vein thrombosis)
DVT ~ 40% low dose warfarin in pts who justify risk of anticoagulation
Nonunion
Fracture of Femoral shaft
Anatomy review
Distal 1/3 rd fracture
A.poplitea and V.poplitea
M.beceps femoris
M.gastrocnemii
Winquist 1980 classification
Coronal Section
Bony structure
AP Hip Lateral Hip
The neck shaft angle
When it is >127º ,
collum valgum .
The normal neck shaft angle is 127º .
When it is <127º ,
The Garden classification
• This classification is based on the degree of displacement shown on the anteroposterior (AP)radiograph • The Garden classification is of prognostic value for the incidence of avascular necrosis, the higher the Garden number, the higher the incidence
Methods of treatment
• Internal fixation 1, multiple pins 2, crossed screw-nails 3, compression with dynamic screw and plate • Arthroplasty AMP for pts more than 70 THR for pts less than 70
Differential diagnoses
• The intertrochanteric fracture 1, very unstable 2, mal-union is almost inevitable unless they are fixed internally 3, usually external rotation degree>90° • The intertrochanteric dislocation
Classification according to Pauwells’ angle
•Pauwells’ angle <30º is abduction fracture, which is a horizontal and stable fracture that has the lowest risk of nonunion
3. Distal 1/3 rd fracture
proximal 1/3rd fracture
M.gluteus medius M.iliopsoas
M. adductor
Middle 1/3 rd fracture
M.iliopsoas M.gluteus medius
M. adductor
• late segmental collapse occurs in
~ 10% undisplaced fracture ~ 30% displaced fracture
2. Failure of fixation • Nonunion
rare in undisplaced fracture ~ 30% in displaced fracture treat with either a valgus osteotomy or an arthroplasty
Posterior View • Popliteal artery and vein • Sciatic Nerve
Causes
• usually high energy trauma
Classification
• by location, fracture pattern, comminution, soft tissue injury, mechanism
Neck of Femur fractures
Pipkin Fracture
• Fracture of femoral head in association with posterior dislocation of hip
The clinical presentations
• Pain on stressing the hip joint • Swelling and bruising around the fracture • Impaired function • Displaced fracture at the upper end of the femur
Shortening Angulation
Rotation
Descriptive animation
Typical displacement realitive to the different location of the fracture
1.proximal 1/3rd fracture 2. Middle 1/3 rd fracture