Lower Limb Fractures

Overview

• 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 of Fractures

• 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

• 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.

Diagnosis

• 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

• Initial: ABCDE approach, pain management, and immobilization.
• 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.

Complications

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

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.