Lower limb fractures

Lower limb fractures

Acetabular fractures













Acetabulum fractures can involve one or more of the two columns, two walls or roof within the pelvis


Mechanism of injury

high energy trauma in younger patients (e.g., motor vehicle accidents)

low energy trauma in elderly patients (e.g., fall from standing height)

Associated conditions

lower extremity injury
nerve palsy
spine injury
systemic injuries
head injury
chest injury
abdominal injury
genitourinary injury

corona mortis anastomosis of external iliac (epigastric) and internal iliac (obturator) vessels
at risk with lateral dissection over superior pubic ramus

classifed as 5 elementary and 5 associated fracture patterns

Imaging
• Radiographs
• AP
• CT scan
indications
now considered a gold standard in management
Duplex doppler ultrasound
indications
rule out DVT

Treatment

• Nonoperative
• protected weight bearing for 6-8 weeks
• indications
• high operative risk (e.g., elderly patients, presence of DVT)
• morbid obesity
• minimally displaced fracture (< 2 mm)

• DVT prophylaxis if slow to mobilize

• close radiographic follow-up

Operative treatment

open reduction and internal fixation
indications
physiologically stable
no local infection
pregnancy is not contraindication to surgical fixation
displacement of roof (> 2 mm)
intra-articular loose bodies
irreducible fracture-dislocation


total hip arthroplasty indications
usually elderly patients with pre-existing arthritis
post-traumatic arthritis in all ages

Complications

• Post-traumatic DJD
• most common complication
• Heterotopic Ossification
• Osteonecrosis
• DVT and PE
• Infection
• Bleeding
• Neurovascular injury
• Intra articular hardware placement
• Abductor muscle weakness

osteonecrosis

Methods of treatment