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Injuries around leg

Dr Abhishek Pathak

Asst. Prof

Deptt of Orthopaedics & traumatology

Gandhi Medical college Bhopal

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Bones

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TIBIAL PLATEAU

DIAPHYSIS

PLAFOND/ PILON

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Tibial plateau fracture

Caused by high-energy mechanisms

associated with neurological and vascular

injury, compartment syndrome

caused by motor vehicle accidents or bumperstrike injuries KNOWN AS BUMPERS

FRACTURE.

Classified by SHATZEKARCLASSIFICATION

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SHATZEKAR CLASSIFICATION

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BUTRESS PLATING HYBRID FIXATURE

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TIBIAL SHAFT FACTURE

Tibia major weight bearing bone

Fibula transmits only 10% of body weight

Both bones are joined together by

1. Ligaments at upper and lower ends

2. Interosseous membrane

Mostly both bones fractures together

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Very common injury

High speed RTA

PECULIARTIES

1. Subcutaneous bone

2. Lack of muscle cover

3. Precarious blood supply b/c of decreased

periosteal blood supply

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Mode of injury

1. Direct most common

2. Indiect twisting injury

spiral or oblique #

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Most of the tibial shaft fractures are open

1. Difficult to manage

2. Increased morbidity

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Diagnosis

1. History

2. Pain

3. Swelling

4. Deformity

5. Wound :- if compound #

6. Crepitus.

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History AMPLE

A Allergies

M Medications

P Past illnesses

L Last meal

E Events / Environment

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What to do??

In all trauma cases first look for

1. A

2. B

3. C

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What to do??

In all trauma cases first look for

1. A AIRWAY

2. B BREATHING

3. C CIRCULATION

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What to do??

In all trauma cases first look for

1. A AIRWAY

2. B BREATHING

3. C CIRCULATION

4. D DISABILTY

5. E EXPOSURE

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LOOK FOR OTHER INJURIES

ALWAYS CHECK DISTAL PULSES,

MONITER VITALS

RADILOGICAL EXAMINTION AFTER PATIENT

STABLIZATION

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DORSAL PEDIS ATRERY

POSTERIOR TIBIAL ARTERY

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TREATNENT

PAIN CONTROL

Splinting by A/K Plaster Slab

Analgesic SOS

Skeletal traction in tibial plateau fracture

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Patient complaining of excessive pain

after # BB leg

Open slab immediately

Watch for tense compartment of leg

COMPARTMENT SYNDROME

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Compartment syndrome as an elevation of

the interstitial pressure in a closed

osseofascial compartment that results in

microvascular compromise

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COMPARTMENT SYNDROME

FIVE Ps

1. Pain: pain out of proportion to that expected

with the injury

2. Pallor

3. Paresthesias

4. Paralysis.

5. Pulselessness A VERY LATE SIGN

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If compartmental pressures are greater than

30 mm Hg in the presence of clinical findings,

immediate fasciotomy is indicated.

Difference between compartment pressure

and diastolic pressure more imp indicator of

tissue perfusion.

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Not all signs need to be present

Only clinical basis is enough is sufficient to do

a fasciotomy

All compartment of leg should be released

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Treatment.

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Treatment

Conservative

Operative

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Conservative treatment

closed #

Undisplaced or minimally displaced

In children

Poor surgical risk

Method

Above knee cast

PTB cast

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Cast bracing

sarmiento

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operative

Method of coice

Early mobilisation

Many methods

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Interlocking nails

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ORIF with DCP

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External fixature

Mainly for open fracture

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INFECTION

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NONUNION

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ARDS

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MASSIVE PULMONARY

EMBOLISM

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Phemister grafting

Used for treatment of nonunion of tibial shaft

fracture

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Tibial plafond fracture

Lower end tibial fracture

Associated with soft tissue injury.

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Crush Injury syndrome

Crush syndrome firstrecorded in bombingof London duringWWII: 5 people who

were crushedpresented in shockwith swollenextremities, dark

urine. Later died from renal

failure.

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MESS

Mangled extremity severity score

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Type Characteristics InjuriesPoints

SKELETAL/SOFT TISSUE GROUP

1. Low energy Stab wounds, simple closed fractures, 1

small-caliber gunshot wound

2. Medium energy Open or multiple-level fractures, 2

dislocations, moderate crush injuries3. High energy Shotgun blast (close range), high-velocity 3

gunshot wounds

4. Massive crush Logging, railroad, oil rig accidents 4

SHOCK GROUP

1 Normotensive hemodynamics Blood pressure stable in field and 0

in operating room

2 Transiently hypotensive BP unstable in field but responsive to 1

intravenous fluids

3Prolonged hypotension Systolic blood pressure less than 90 mm 2

Hg in field and responsive to intravenous

fluid only in operating room

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ISCHEMIA GROUP

1 None A pulsatile limb without signs of ischemia 0

2Mild Diminished pulses without signs of ischemia 1

3Moderate No pulse by Doppler, sluggish capillary refill 2

paresthesia, diminished motor activity

4Advance Pulseless, cool, paralyzed and numb 3

without capillary refill

AGE GROUP

130 50 yrs 2

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limbs with scores of 7 to 12 ultimately

required amputation, whereas scores of 3 to 6

resulted in viable limbs.