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LOWER LIMB
Dr Vindye R Walpola
Lecturer in Anatomy
Department of Anatomy
FEMUR
Ossification of femur
Trochanteric anastomosis
The vessels in the round ligament of the head are insufficient to prevent
avascular necrosis.
FRACTURE NECK OF THE FEMOR
Non-union may be due to the effect of the synovial fluid which bathes the
fractured fragments and inhibits osteogenesis.
When the fracture of the neck is close to the shaft it is partly intracapsular and
partly extracapsular and union is better than the subcapital fracture.
a. There is a definite (true) shortening of the limb because the distal fragment
is pulled upward by the rectus femoris, the adductors and the hamstrings
with overlap of the two fragments.
b. The distal fragment is also laterally rotated by the lateral rotators which are
stronger than the medial rotators.
FRACTURE SHAFT OF THE FEMUR
(Just below the lesser trochanter)
Proximal fragment
Abducted by the gluteus medius and
minimus.
Laterally rotated by the gluteus
maximus, piriformis, obturators and
quadratus femoris.
Flexed by the iliopsoas which is
attached to the lesser trochanter.
Distal fragment
Pulled upward behind the proximal
fragment by the hamstrings and the
quadriceps femoris
Adducted and laterally rotated by the
adductors
FRACTURE SHAFT OF THE FEMUR
(At its middle third)
Distal fragment
Superiorly by quadriceps
Is it common in women?
Females seem to have a greater risk for patellar dislocations than males.
Direct
Direct blow during fall onto knee or when it hits dashboard in RTA.
Because of small amount of prepatellar soft tissue and direct contact with the
femur posteriorly, nearly all of force is delivered to patella.
Indirect
Can be due to jumping or unexpectedly rapid flexion of the knee against fully
contracted quadriceps.
Fractures of this type tend to be less comminuted than those from direct
trauma, but they are displaced and are often transverse.
PATELLA FRACTURE
FRACTURE OF TIBIA AND FIBULA
The nutrient artery to the tibia is directed towards the lower end.
Therefore, it may be torn in fracture of the distal 1/3 of the tibia resulting in
ischaemic necrosis with delayed union or non-union.
FRACTURE IN DISTAL END OF THE LEG
These fractures are very common and result from indirect violence with the
following possibilities.
Both the medial malleolus and the lateral malleolus may be fractured
together (Potts fracture).
The talus may be thrust upward between the tibia and fibula
(Dupuytrens fracture).
Potts fracture
Symptoms include
Severe pain
Unable to put weight on the injured leg and the ankle will feel unstable
Tenderness at the point of the fracture, usually over malleoli.
FRACTURES OF THE FOOT
MT stress fractures are most commonly seen in the 2nd and 3rd MTB.
Stress fractures of the 4th and 5th MTB are rare and least on1st MTB.
Thank you...