FRACTURES OF

PELVIS & LOWER

EXTREMITY
JOSELITO T. DYCHIOCO, MD,
FPCS, FPOA
 At the end of the lecture,
the student should be able
to:
• Describe the signs and symptoms of
fractures & dislocations of the pelvis and
lower extremity
• Differentiate the different types of fractures
& dislocations of the pelvis and lower
extremity and their pathophysiology
• Describe the initial diagnostic workup and
treatment of these fractures
• Enumerate the possible
complications of these fractures &
dislocations
• Determine which fractures &
dislocations need referral to the
proper specialist
VEHICULAR ACCIDENT
FRACTURES OF THE
PELVIS
 PELVIC STABILITY
• stability of the pelvis can be divided into anterior
and posterior stability. The anterior stability
contributes 40% of the strength of the pelvis, while
60% of the pelvis' strength is derived from the
posterior stabilizing structures.
• It is interesting to note that the pelvis will remain
stable if completely disrupted anteriorly as long as
the posterior support is not disturbed.
 Morel-Lavallee Lesion
• Is an ecchymotic lesion over greater
trochanter represents a
subcutaneous degloving injury,
usually asso w/ acetabular fracture
PELVIC COMPRESSION
TEST
ANT-POST COMPRESSION
LATERAL COMPRESSION
VERTICAL SHEAR
UNSTABLE PELVIC
FRACTURE
 PELVIC ORGANS AND
HEMORRHAGIC SHOCK
OPEN PELVIC FRACTURE
OPEN REDUCTION & INT’L
FIXATION OF PELVIC
FRACTURE
ACETABULAR FRACTURE
ACETABULAR FRACTURES
CT-SCAN ACETABULAR
FRACTURE
CT-SCAN WITH 3D IMAGE
ORIF ACETABULAR
FRACTURE
POST-OP X-RAYS
FEMORAL HEAD FRACTURES
 ACETABULAR WITH
FEMORAL HEAD FRACTURE
ORIF FEMORAL HEAD
FRACTURE
FRACTURES OF THE LOWER
EXTREMITY
• -HIP DISLOCATION
• -PROXIMAL FEMUR
• -FEMORAL SHAFT
• -KNEE
• -TIBIA
• -ANKLE
• -FOOT
DASHBOARD TYPE
INJURY
HIP DISLOCATION
 Avascular Necrosis of
Femoral head
• Occurs in 100% of cases, if hip
remains dislocated for 24 hours
• In the dislocated position, tension on
the capsular blood vessels restrict
blood flow to the femoral head
• Reduction within 6 hours reduce
incidence of ischemic changes
BILATERAL HIP
DISLOCATION
MANEUVERS FOR CLOSED
REDUCTION
FEMORAL NECK
FRACTURE
BLOOD SUPPLY OF
FEMORAL HEAD
FEMORAL NECK FRACTURE
XRAY
HIP PROSTHESIS
 INTERTROCHANTERIC
FRACTURE AND HIP SCREW
FLOATING KNEE
INTERLOCKING FEMORAL
NAIL
FEMORAL SHAFT FRACTURE
IN CHILDREN
APPLICATION OF HIP
SPICA
HEALING OF FEMORAL
SHAFT FRACTURE IN A
CHILD
KNEE ANATOMY
KNEE LIGAMENTS
KNEE DISLOCATION
• More than half of
all knee
dislocations are
anterior or
posterior, and both
of these have a
high incidence of
popliteal artery
injury.
Popliteal Artery
UNHAPPY TRIAD OF
O’DONOGHUE
VALGUS STRESS TEST
Patellar Fractures
Cerclage Wiring for Patellar
Fracture
Patellar Fracture X-rays
OPEN FRACTURES
Gustilo Classification of
Open Fx
External Fixature for Open
Tibial Fx
ANKLE FRACTURES
Ankle Fracture
Tri-Malleolar Fracture
Maisonneuve fracture
• Maisonneuve
Fracture X-ray
Achilles Tendon Rupture
 Thompsen’s Test for
Ruptured Achilles Tendon
Talar fracture
Calcaneal Fracture
X-ray of Calcaneal
Fracture
ORIF of Calcaneal
Fracture
Fractures of Forefoot
5 Metatarsal Fracture
th
ORIF 5th Metatarsal
Fracture
Multiple Metatarsal
Fractures
Stress Fracture