Fracture lower extremities Part I
Pelvic fracture
- Anatomy of pelvic ring
- Bone
- Joint
- Ligament
- Clinical Features
- Asso injury
- massive hemorrhage
- Intraabdominal injury
- Lower limb injury
- PE
- Pelvic compression test
- Perineum and genital examination
- Classification
- AP compression
- Lateral compression
- Vertical shear
- Investigation
- Plain film
- Pelvis (AP, Inlet, outlet)
- CT scan
- Treatment
- Emergency management
- ATLS protocol
- pelvic binder ,external fixation
- angiographic embolization
- Definite treatment
- Minimal displace fracture
- bed rest
- AP compression
- external fixator, Anterior plate and screw
- Lateral compression
- external fixation, plate fixation ,scroilliac screw
- Open pelvic fracture
- diversion colostomy
- Minimal displace fracture
- Complications
- Urologic complication
- Sciatic nerve injury
- Thromboembolism
Acetabular fracture
- Anatomy of pelvic ring
- Anterior column (iliopubic component)
- Posterior column (ilioischial component)
- Acetabular roof
- Clinical Features
- Classification
- Letournel and Judet
- Simple หรือelementary fractures
- anterior posterior column fracture
- anterior posterior wall fracture
- transverse fracture
- Complex fractures
- Combination
- Simple หรือelementary fractures
- Investigation
- Plain X-ray
- pelvis AP
- Judet views
- Iliac oblique
- Special imaging: CT scan
- Treatment
- Emergency management
- Volume/fluid resuscitation
- Close reduction
- skeletal traction
- Definite treatment
- Conservative treatment (skeletal traction 6-8 weeks)
- Non-displaced และ minimally displaced (< 2mm)
- Non-weight bearing zone
- Both column fracture with secondary joint congruence
- Operative treatment โดยใช้reconstruction plate-screw
- Displaced fracture ( 2mm) in wt. bearing
- Posterior wall fracture(>50%)
- Incarcerated fragment
- Complications
- Iliofemoral venous thrombosis
- Sciatic nerve injury
- Heterotopic bone formation
- Avascular necrosis
- Post-traumatic osteoarthritis
Hip fracture
- Osteoporosis
- trivial trauma
- Clinical Features
- Falling
- Shortening
- External rotation
- Ecchymosis
- Rolling test
- Anvil test
- Investigation
- Plain X-ray
- Hips (AP , Lateral)
- Special imaging: CT scan
Classifications
- Femoral neck fracture
- Garden Classification(I-IV)
- Anatomical classification
- Sub-capital fracture
- Mid-cervical fracture
- Basilar neck fracture
- Intertrochanteric fracture
- Boyd & Griffin classification
- Type I-IV
- Evan classification
- Stable VS unstable
Treatment
-Initial treatment : Skin traction
- Femoral neck fracture
- Internal fixation non-displaced fracture (Garden I และ
- Prosthetic replacement displaced fracture (Garden III และ
- Hemiarthroplasty
- Total hip replacement
- Intertrochanteric fracture
- Internal fixation( sliding hip screw-plate short cephalomedullary nail)
- Prosthetic replacement
- Complications
- Venous thromboembolism (deep vein thrombosis ,pulmonary embolism)
- Decubitus ulcer (bedsores)
- Urinary tract infection
- Pulmonary complication : pneumonia, atelectasis
- Non-union
- AVN
- Malunion
- Fixation failure
- Post-operative care
- Early ambulation
- Osteoporosis treatment