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  2. 2. ❖Femur ❖Tibia and Fibula ❖Patella ❖Ankle ❖Calcaneal ❖Metatarsals LOWER LIMB FRACTURES
  3. 3. FEMORAL FRACTURES • Proximal end • Shaft • Distal end
  4. 4. PROXIMAL END ▪ Intracapsular ▪ Capital : Fracture of the head ▪ Subcapital :below the femoral head ▪ Transcervical :across the mid-femoral neck ▪ Basicervical :across the base of the femoral neck. ▪ These injuries (last three)may be correctly termed fractures of the 'neck of femur' (NOF).
  5. 5. ▪ Extra Capsular ▪ Intertrochanteric ▪ Subtrochanteric Shaft ▪ ▪ Distal end ▪ Supracondylar ▪ Condylar
  6. 6. Intracapsular fracture – Subcapital
  7. 7. Intertrochanteric fracture
  8. 8. Subtrochanteric fracture
  9. 9. THE GARDEN CLASSIFICATION OF FEMORAL NECK FRACTURES ▪ Based on the degree of displacement on the anteroposterior radiographs. Differentiation has therapeutic as well as prognostic value. ▪ ▪ Type I and II fractures have a low incidence of avscular necrosis .
  10. 10. GRADI NG Grade 1: incomplete impacted fracture of the femoral neck. Grade 2: complete undisplaced fracture. Grade 3: complete fracture with moderate displacement. ▪ ▪ ▪ ▪ Grade 4: severely displaced fracture.
  11. 11. PAUWELS CLASSIFICATION ▪ Pauwels classification refers to the angle the fracture line makes with the horizontal
  12. 12. Grade 1 Grade 2 Grade 3
  13. 13. GARDEN… .? Grade 1
  14. 14. GARDEN… ? Grade 4
  15. 15. FEMORAL SHAFT FRACTURES ▪ Femoral fractures require high force trauma ▪ Pathological fractures in old osteoporotic ▪ AP and lateral views
  16. 16. Spiral fracture with posterior angulation, lateral displacement and shortening
  17. 17. Pathological femoral shaft fracture Transverse fracture with rotational displacement and shortening
  18. 18. FRACTURES OF LOWER END OF FEMUR ▪ Extra-articular or supracondylar in which the fracture does not extend to the knee joint line.
  19. 19. PARTIAL-ARTICULAR / CONDYLAR The fracture extends to the knee joint line but part of the condyles remain attached to the femur shaft.
  20. 20. COMPLETE-ARTICULAR OR INTERCONDYLAR The fracture extends to the knee joint line but the condyles are completely separated from the femur shaft.
  21. 21. SUPRACONDYLAR FRACTURES • The lower fragment is drawn backward by the gastrocnemius and plantaris, and the popliteal vessels and internal popliteal nerve may either be wounded or stretched over its sharp upper edge. The artery lying deepest is the most liable to injury, then the vein, and finally the nerve.
  22. 22. Supracondylar fracture
  23. 23. Fracture medial condyle
  24. 24. Bipartite patella
  25. 25. Patellar fracture- haemarthrosis
  26. 26. ❖Tibial plateau fracture ❖Stress fractures ❖Toddlers fracture
  27. 27. TIBIAL PLATEAU FRACTURES ▪ Fractures of the tibial plateau can be subtle or wide displacement with varying degrees of comminution. ▪ There may be depression of the plateau surface, displacement of a fracture fragment or both. ▪ Lipohaemarthrosis.
  28. 28. Lateral tibial plateau fracture The fracture fragment is displaced and depressed from its normal position
  29. 29. Depressed tibial plateau contour- Lipohaemarthrosis
  30. 30. Tibial and fibular fracture
  31. 31. Tibial stress fracture
  32. 32. Toddler's fracture Fine spiral line through the tibial shaft
  33. 33. ANKLE FRACTURES Lateral malleolar fractures ▪ Lateral malleolar fractures are categorized according to their position in relation to the distal tibiofibular syndesmosis at the level of the ankle joint.
  34. 34. WEBER FRACTURE CLASSIFICATION Weber A = Distal to ankle joint Weber B = At level of ankle joint ▪ ▪ ▪ Weber C = Proximal to ankle joint
  35. 35. Lateral malleolus fracture(Weber A)
  36. 36. FINDINGS & WEBER…? Bimalleolar fracture (Weber B)
  37. 37. Trimalleolar fracture
  38. 38. MAISONNEUVE FRACTURE Spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane. There is an associated fracture of the medial malleolus or rupture of the deep deltoid ligament.
  39. 39. Maisonneuve fracture
  40. 40. OSTEOCHONDRAL FRACTURES Occasionally ankle trauma causes a fracture of the talus bone surface. These 'osteochondral' injuries are often subtle and so this area should be assessed carefully on all post-traumatic ankle X-rays.
  41. 41. Osteochondral fracture Loss of the normal talar dome cortex contour due to an osteochondral fracture
  42. 42. CALCANEAL FRACTURES • Falling from height can lead to severe calcaneal fractures, which may be accompanied by axial loading fractures of the spine. ▪ ▪ Calcaneal fractures due to a fall from height are often comminuted and intra-articular.
  43. 43. BOHLER’S ANGLE ▪ A line is drawn from the tuberosity to the most superior part of the posterior facet. ▪ Another line is drawn from the most superior part of the facet to the anterior process. Normally the angle created is between 20 and 40 degrees. ▪ ▪ If the angle is less than 20 degrees, this indicates depressed fracture.
  44. 44. BOHLER’S ANGLE
  45. 45. THE CRITICAL ANGLE OF GISSANE • It is formed by a line along the lateral margin of the posterior facet and another line extending anterior to the beak of the calcaneus. The normal value is 95 to 105 degrees with an increase representing posterior facet collapse
  46. 46. TYPES OF CALCANEAL FRACTURES • Intra and Extrarticular fractures on the basis of subtalar joint involvement. ▪ Intrarticular fractures are more common and involve the posterior talar articular facet of the calcaneus. ▪ Extrarticular fractures are less common, and located anywhere outside the subtalar joint.
  47. 47. THE SANDERS SYSTEM CLASSIFICATION Is the most commonly used system for categorizing intrarticular fractures. Classifies these fractures into four types, based on the location of the fracture at the posterior articular surface.
  48. 48. TYPES ▪ Type I fractures are non-displaced fractures (displacement < 2 mm). ▪ Type II fractures consist of a single intrarticular fracture that divides the calcaneus into 2 pieces. ▪ Type III fractures consist of two intrarticular fractures that divide the calcaneus into 3 articular pieces. ▪ Type IV fractures consist of fractures with more than three intrarticular fractures.
  49. 49. METATARSAL FRACTURES ▪ ▪ ▪ Oblique fracture of 5thmetatarsal shaft 5TH Metatarsal base fracture Metatarsal stress fractures Stress fractures of the metatarsals are common in athletically active individuals. These may not be visible on initial X-rays but follow up images show periosteal stress reaction. This has the appearance of fusiform bone expansion.
  50. 50. NORMAL UNFUSED 5TH METATARSAL bone apophysis is aligned more longitudinally along the bone
  51. 51. THANK YOU