Lower limb fractures on plain x ray

1. Lower limb fractures

2. Lower limb fractures
Femur
Tibia and Fibula
Patella
Ankle
Calcaneal
Metatarsals

3. FEMORAL FRACTURES
• Proximal end
• Shaft
• Distal end

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.  Extra Capsular
 Intertrochanteric
 Subtrochanteric
 Shaft
 Distal end
 Supracondylar
 Condylar

7. Intracapsular fracture – Subcapital

8. Intertrochanteric fracture

9. Subtrochanteric fracture

10. 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 .

11. Grading
 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.

12. Pauwels classification
 Pauwels classification refers to the angle the fracture line
makes with the horizontal

13. Grade 1 Grade 2 Grade 3

14. Garden….?
Grade 1

15. Garden…?
Grade 4

16. FEMORAL SHAFT FRACTURES
 Femoral fractures require high force trauma
 Pathological fractures in old osteoporotic
 AP and lateral views

17. Spiral fracture with posterior angulation, lateral
displacement and shortening

18. Pathological femoral shaft fracture
Transverse fracture with rotational displacement and shortening

19. Fractures of lower end of femur
 Extra-articular or supracondylar in which the fracture does
not extend to the knee joint line.

21. Partial-articular / condylar
The fracture extends to the knee joint line but part of the
condyles remain attached to the femur shaft.

23. Complete-articular or intercondylar
The fracture extends to the knee joint line but the
condyles are completely separated from the femur
shaft.

25. 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.

27. Supracondylar fracture

28. Fracture medial condyle

29. Bipartite patella

30. Patellar fracture- haemarthrosis

31. Tibial plateau fracture
Stress fractures
Toddlers fracture

32. 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.

33. Lateral tibial plateau fracture
The fracture fragment is displaced and depressed from its normal
position

34. Depressed tibial plateau contour- Lipohaemarthrosis

35. Tibial and fibular fracture

36. Tibial stress fracture

37. Toddler's fracture
Fine spiral line through the tibial shaft

38. 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.

39. Weber fracture classification
 Weber A = Distal to ankle joint
 Weber B = At level of ankle joint
 Weber C = Proximal to ankle joint

40. Lateral malleolus fracture(Weber A)

42. Findings & Weber…?
Bimalleolar fracture (Weber B)

43. Trimalleolar fracture

44. 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.

45. Maisonneuve fracture

46. 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.

47. Osteochondral fracture
Loss of the normal talar dome cortex contour due to an osteochondral
fracture

48. 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.

49. 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.

50. Bohler’s Angle

51. 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

53. 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.

54. 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.

55. TYPES
 TTyyppee II ffrraaccttuurreess are non-displaced fractures (displacement <
2 mm).
 TTyyppee IIII ffrraaccttuurreess consist of a single intrarticular fracture that
divides the calcaneus into 2 pieces.
 TTyyppee IIIIII ffrraaccttuurreess consist of two intrarticular fractures that
divide the calcaneus into 3 articular pieces.
 TTyyppee IIVV ffrraaccttuurreess consist of fractures with more than three
intrarticular fractures.

57. Metatarsal Fractures
 Oblique fracture of 5th metatarsal 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.

59. NORMAL UNFUSED 5TH METATARSAL bone apophysis is
aligned more longitudinally along the bone

60. THANK YOU