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Lower limb fractures

Surgery > Orthopaedic

Background knowledge 🧠

Definition

  • Lower limb fractures involve injuries to the bones of the lower extremity, including the hip, femur, knee, tibia, fibula, ankle, and foot.
  • These fractures vary significantly in severity and treatment, depending on the location, type of fracture, and patient factors.

Types

  • Hip Fractures: Often occur in the elderly due to osteoporosis. Classified as intracapsular (femoral neck) or extracapsular (intertrochanteric).
  • Femur Fractures: Can be proximal, shaft, or distal. High-energy trauma in younger patients; low-energy in elderly.
  • Tibial and Fibular Fractures: Commonly result from direct trauma or rotational injuries.
  • Ankle Fractures: Involving the tibia, fibula, or both (bimalleolar).
  • Foot Fractures: Including metatarsals, phalanges, and calcaneus, often due to direct impact or stress injuries.

Clinical Features 🌡️

Clinical Features

  • Pain, swelling, and deformity at the site of injury.
  • Inability to bear weight.
  • Bruising and soft tissue injury.
  • Potential neurovascular compromise, particularly in high-impact injuries.

Investigations 🧪

Tests

  • Clinical assessment followed by imaging.
  • X-rays are the first line; CT or MRI may be required for complex fractures.
  • Assessment of surrounding soft tissue, vascular and nerve status.

Management 🥼

Management

  • Initial: ABCDE approach, pain management, and immobilisation.
  • Definitive Treatment: Varies by fracture type.
    • Surgical intervention often required for hip, femur, and unstable lower leg fractures.
    • Conservative management (casting or bracing) may be suitable for certain tibial, fibular, and foot fractures.
  • Rehabilitation: Crucial for functional recovery. Includes physiotherapy and gradual weight-bearing as tolerated.

Special Considerations

  • Elderly Patients: Higher risk for complications due to osteoporosis and comorbidities.
  • Open Fractures: Require urgent surgical debridement to prevent infection.
  • Polytrauma Patients: Require a multidisciplinary approach for management.

Complications

  • Acute: Haemorrhage, compartment syndrome, venous thromboembolism.
  • Long-term: Malunion, nonunion, osteoarthritis, chronic pain, and disability.

Key Points

  • Lower limb fractures vary significantly in severity and treatment, depending on the location, type of fracture, and patient factors.
  • Patients present with a painful, swollen and possibly deformed limb with limited mobility.
  • Diagnosis is based on clinical assessment supported by imaging (X-rays are the first line).
  • Management varies, but is split into initial assessment (ABCDE, pain management), definitive treatment (surgical or conservative) and rehabilitation (crucial for functional recovery).
  • Special considerations in management are required for the elderly, open wounds and polytrauma.

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Orthopaedic