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:
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).
