lower limbs

• Lower limb fractures

  Fractures of the femur (hip), tibia, fibula, patella, ankle, calcaneus, and metatarsals
• Lower limb fractures

  • Can result from high-energy trauma or osteoporosis in the elderly
  • Treatment depends on the type and location of the fracture, ranging from closed reduction and casting to open reduction with internal fixation using plates, screws, or intramedullary nails
• Pelvic fractures may also require surgical fixation depending on the forces involved and stability of the injury
• Humerus fracture


  Fracture of the upper arm bone
• Humerus fractures


  • Can result from direct trauma or falls
  • Symptoms include pain, deformity, and abnormal mobility
  • Treatment involves splinting or casting for minor fractures and surgical intervention using plates, nails, or external fixation for more complex fractures
  • Complications can include nerve injuries, nonunion, malunion, and stiffness
• Clavicle fracture


  Fracture of the collarbone
• Clavicle fractures


  • Most commonly occur in the middle third and are usually treated conservatively with sling immobilization
  • Scapula fractures often associated with life-threatening injuries requiring assessment by ATLS protocols and are also initially treated with sling immobilization
• Femoral neck fracture


  Fracture of the neck of the femur
• Femoral neck fractures

  • Most commonly occur in the elderly due to falls
  • Treatment depends on the fracture type and patient age/health but may involve internal fixation, hemiarthroplasty or total hip replacement
  • Complications can include nonunion, avascular necrosis and osteoarthritis
• Ankle injury

  Injury to the ankle joint composed of the tibia, fibula, and talus
• Ankle injuries


  • Displacement of the talus within the ankle mortise by only 1 mm decreases the contact area by 42%
• Supracondylar fracture


  Fracture above the condyles of the humerus
• Upper limb fractures

  Fractures of the clavicle, scapula, humerus, radius, ulna, carpals and metacarpals
• Upper limb fractures

  • Treatment depends on the specific bone and location of the fracture
  • Most common fractures like clavicle and humerus can be treated conservatively with slings or plates/screws for displaced fractures
  • More complex fractures involving joints often require open reduction and internal fixation to restore anatomy
  • Complications include nonunion, malunion, nerve palsies and joint stiffness
• Patella fracture


  Fracture of the kneecap
• Patella fractures


  • Can result from direct trauma from a fall or indirect trauma from forceful quadriceps contraction
  • Fractures are classified as undisplaced or displaced
  • Treatment depends on the type of fracture, and may involve casting, tension band wiring, or patellectomy
  • Complications can include non-union, avascular necrosis, osteoarthritis, or knee stiffness
• Intertrochanteric fracture


  Fracture between the greater and lesser trochanters of the femur
• Intertrochanteric fractures


  • Internal fixation with devices like the dynamic hip screw or proximal femoral nail is now the standard of care to allow early mobilization
  • Surgical techniques like closed or open reduction may be used along with supplemental procedures like medial displacement osteotomy in unstable patterns
• Neck of femur fracture


  Fracture of the femoral neck
• Neck of femur fractures

  • Typically occur in elderly patients from low-energy falls and are associated with osteoporosis
  • Treatment depends on factors like the patient's age, health, and fracture classification, and may involve closed or open reduction, fixation with screws or nails, or arthroplasty
  • Complications can include nonunion, osteonecrosis, fixation failure, dislocation, and increased mortality risk especially in older or less healthy patients
• Shoulder dislocation

  Separation of the humeral head from the scapula
• Shoulder dislocations

  • The most common type is an anterior dislocation, accounting for 95% of cases
  • Risk factors include age and previous trauma
  • Signs and symptoms include loss of normal shoulder contour, pain, and decreased range of motion
  • Treatment involves reduction, immobilization, and physical therapy
  • Prognosis depends on age, with younger patients having a higher risk of recurrence
• Monteggia fracture


  Fracture of the ulna bone in the forearm combined with a dislocation of the radial head
• Monteggia fractures


  • Bado's classification system divides them into four main types based on the direction of radial head dislocation and location of the ulna fracture
  • Importance of anatomic reduction and stabilization of both the ulna fracture and radial head dislocation
• Radial nerve palsy

  Injury to the radial nerve
• Radial nerve palsy


  • Can be caused by fractures, compression, or traction injuries
  • Management includes nonsurgical treatment, nerve repair or grafting, and tendon transfers in chronic cases
  • Goal is to restore wrist and finger extension through nerve regeneration or reconstruction of function
• Congenital talipes equino-varus (clubfoot)


  Congenital deformity of the foot and ankle characterized by equinus, inversion, adduction and cavus
• Congenital talipes equino-varus


  • Non-operative treatment is usually attempted first using serial casting and manipulation techniques
  • Surgery may be required in some cases
• De Quervain's tenosynovitis


  Inflammation of the tendon sheaths of the abductor pollicis longus and extensor pollicis brevis muscles in the wrist
• De Quervain's tenosynovitis


  • Commonly affects women ages 30-50 and is caused by repetitive motions like knitting or computer use
  • Conservative treatment involves splinting, anti-inflammatories, corticosteroid injections, and physical therapy exercises
  • Surgery may be considered if symptoms persist after several weeks of conservative care
• Hip dislocation


  Displacement of the femoral head from the acetabulum
• Hip dislocations


  • Can be classified as posterior, anterior, or central
  • Treatment involves closed or open reduction, sometimes along with fixation of any fractures
  • Complications can include myositis ossificans or avascular necrosis leading to osteoarthritis
• Shaft of humerus fractures can result from a fall on an outstretched hand or direct blow to the arm
• Shaft of humerus fractures

  • Treatment involves either hanging casts or surgery depending on the severity of the fracture and any complications
  • Complications can include injury to the radial nerve and non-union of the bone fragments
• Shaft of humerus fracture


  • Can result from a fall on an outstretched hand or direct blow to the arm
  • Treatment involves either hanging casts or surgery depending on the severity of the fracture and any complications
  • Complications can include injury to the radial nerve and non-union of the bone fragments, so careful assessment of nerve function is important both before and after treatment
• Hip dislocation


  Separation of the femoral head from the acetabulum
• Types of hip dislocation

  • Posterior
  • Anterior
  • Central
• Complications of hip dislocation

  • Myositis ossificans
  • Avascular necrosis leading to osteoarthritis
• Treatment of hip dislocation

  1. Closed reduction

  2. Open reduction

  3. Fixation of any fractures
• Hip dislocations are classified based on their location