Lecture 8

Lower Extremity Fracture 2

(Fracture of Lower Leg –Types of
Fracture, Fixation Type)

DR. I WAYAN SURYANTO DUSAK, SP.OT (K)

Fracture in General
Definition

Break in the structural continuity of

bone
• It may be no more than a crack, a crumpling
or a splintering of the cortex
• Caused by sudden and excessive force, which
may be tapping, crushing, bending, twisting or
pulling
Mechanism of Fracture
Types of Fracture
 Fracture Healing

Time of 1-7 d 2-3 w 3-4 m m-y

injury
What Can Happened in Fracture
Healing?
Continou
s
process
Delayed Non-Uni
Union
Union on

Non-Union defined as fracture that has not

healed 9 months post operation and there is
no visible progress of healing during the last
3 months.
Fracture of Lower Leg
Anatomy
Mechanism of injury/ Etiology
High-energy trauma is the commonest mechanism of injury, with diaphyseal fractures occurring more
frequently in younger adults.
Non-accidental injury should always be considered in diaphyseal fractures in children. The fracture pattern
is related to the type of force that produced the break.
A spiral fracture is usually caused by a fall in which the foot is anchored while a twisting force is
transmitted to the femur.
Transverse and oblique fractures are more often due to angulation or direct violence and are therefore
particularly common in road accidents.
With severe violence (often a combination of direct and indirect forces) the fracture may be comminuted,
or a segmental fracture.
Fracture of Lower Leg (Common)
Tibial Tibia and
Ankle
plateau fibula shaft
fracture
fracture fracture
Tibial Plateau Fracture
Classification - Schatzker
Tibia and Fibula Shaft Fracture
Classification - AO
Ankle Fracture
Classification –
Lauge-Hansen/Weber
 Clinical Features

Look
• Deformity
• Swelling
• Open wound
Feel
• Crepitation
• Disrupted distal AVN
Move
• Limited ROM
• False movement
•
Radiologic Examination
X-ray : Rule of Mortise
AP + Two for view for
Lateral children ankle
Two views
Two joints
Two limbs
Two injuries
Two occasions
Treatment

Specific aims of fracture treatment

• To relieve pain
• To obtain and maintain satisfactory position
of fracture fragment
• To allow and if necessary to encourage bony
union
• To restore optimum function
Algorithm
Types of Treatment That Will Be
Discussed
Plate and
Conservative
Screw fixation
Treatment
Intramedullary
Surgical
nailing

External
fixation

Indication for surgical (general): Failure to obtain adequate close

reduction, open fractures, vascular injury, soft tissue precludes
cast application, patient unreliable for closed treatment,
preference for not using cast
 Plate and Screw Fixation
Complications
Indications
- Fractures of both distal and • Infection
proximal end of tibia • Undersized or oversized
- Communitive tibial shaft fracture implant selection
- Fractures accompanied with • Improper number of
vascular injury requiring open repair implants
• Inadequate/improper
Most common fixation method 🡪 screw fixation
relative stability, absolute stability, • Malposition of plate or
load sharing
screw
New technique: minimally invasive • Poor plate contouring
plate osteosynthesis (MIPO) • Fracture gap
 Intramedullary Nailing
Most common treatment of tibial diaphyseal Complications
fractures
• Infection
Surgeon preference (96%) for closed and lower
grade open fracture • Changing limb
axis
Excels in providing either load bearing or load
sharing fixation of tibia with minimal amount of • Rotation of
soft tissue injury compared to plate and screw factions agains
fixation each other
this type of fixation is not recommended for the • Degenerative
management of communitive fracture pattern changes in the
knee
 External Fixation
Indications Complications
• Treatment of severe open injuries
• Management of patients with • Pin site infection
multiple injuries where there is a • Pin drainage
need to reduce operating time
and prevent the second hit • Pin looseing
• The need to deal with severe • Loss of fracture or
bone loss by the technique of joint position
bone transport. External fixation
is also useful for treating femoral
• Neurovascular
fractures in adolescents where injuries
iatrogenic damage to growth • Delayed or
plates can be avoided non-union
Thank You