Diaphyseal Fractures of the lower limb

 

By definition leg fracture tibia and fibula concern.

Frequency is not correlated with the age and osteoporosis

Cutaneous opening exists in 25% of cases

Stress fractures occur on normal bone, without significant trauma by repetitive biasing mechanism

1- Classification:

A- type fracture:

– Type A: simple fracture

– Type B: wedge fracture with third fragment in butterfly wing

– Type C: complex fracture, comminuted

B- Moving the divide:

– Angular: varus-valgus and flexion-recurvatum

– Translational or bayonet

– By shortening

– Rotation

C- Open fracture:

Diaphyseal fractures of the lower limb

Diaphyseal fractures of the lower limb

CLASSIFICATION AND CAUCHOIX DUPARC:

Type I: Opening puncture or small extent without peeling or contusion of the adjacent skin sutured after trimming without tension.

Type II: Wound with risk of secondary necrosis after suture: peel or skin contusion; suture on after trimming.

Type III: Loss of non suturable skin defect after debridement.

Type IIIA: Loss of limited substance, healthy surrounding tissue -> directed healing possible.

Type IIIIB: Loss of extended substance, peeled or surrounding tissue contused -> directed healing impossible.

Nonunion: nonunion beyond 6 months

– Hypertrophic nonunion in bellbottoms

– Atrophic nonunion in candy

– Suppurative pseudarthrosis (nonunion + chronic osteitis)

2- Treatment:

– Theoretical term consolidation

– Indications of conservative treatment are:

* Non-displaced fracture and stable

* Fracture young child

– The intramedullary nailing is the best treatment for closed fractures

– Supports open fracture:

MANAGEMENT OF OPEN FRACTURES:

* EMERGENCY: antibiprophylaxie preventing tetanus + + removal of foreign bodies and wash with saline + dressing antiseptic and limb alignment in a knee-ankle-pedal brace.

* BLOCK IN:

– First time -> trimming and washing

– Second time -> fracture fixation

* Stage I and II: intramedullary nailing

* Stage III: external fixator or amputation (ischemia).

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