Lower Limb Fractures
Fractures of the lower limb are common. They are often associated with considerable morbidity and a lengthy hospital stay. An understanding of lower limb trauma, it's cause and management is important.
Femur
The femur or thigh bone is the longest, and strongest bone of the body. It forms part of the hip and part of the knee.
Pain, swelling and haemorrhage are associated with fractures in the affected limb, these can be life threatening due to the vascular supply to the bone. On examination the leg may be shorter than the unaffected side with possible external rotatation. The neck of the femur and the shaft are the most common sites of fractures seen in the femur.
Due to osteoporosis, fractures of the neck of the femur are common in the elderly. Rotational forces acting on the bone most often cause the fracture when the patient slips and falls. Immobilising the affected limb by strapping it to the unaffected side gives more support to the fractured limb.
Major trauma such as experienced in a road accident or a fall from a height is a primary cause for fractures of the shaft of the femur. Immobilising the affected limb can be achieived by a traction splint but if this is not possible then strap it to the unaffected side gives as much support to the fractured limb.
Patella
The patella or kneecap is a thick, triangular bone which articulates with the femur and covers and protects the front of the knee joint. It is the largest sesamoid bone in the human body.
Patella fractures are caused by:
Trauma when involved in a road traffic accident e.g. when the knee strikes the dashboard.
Falling directly on a hard surface.
Heavy object falling on the knee
Immobilisation of the knee can be achieved using a long leg splint.
Tibia and Fibula
The tibia is the larger of the two bones in the leg below the knee. The fibula is the bone located on the lateral side of the tibia, with which it is connected above and below. It is the smaller of the two bones, and, in proportion to its length, the most slender of all the long bones.
Tibia and fibula fractures may result from direct trauma or indirect trauma.
Pain, swelling and haemorrhage are associated with fractures in the affected limb, these can be life threatening due to the vascular supply to the bone.
Immobilisation can be achieved using a padded splint.
Foot
The tarsi are the cluster of bones in the foot between the tibia and fibula and the metatarsus.
These bones provide stability, absorb shocks, bear weight and aid in movement.
Fractures of the bones of the ankle and foot can occur from crush injuries, a fall from height or a rotational force.
Immobilisation can be achieved using a padded splint
Management
Reassurance, Entonox for pain relief, Stop any haemorrhaging, Immobilise the affected area above and below
injury, check for circulation of affected part, feel for
distal pulses and for sensory loss numbness or
pins and needles if there is any major deficit in
circulation or sensory then the fracture will need to be
reduced to near as normal, remove any tight clothing or
jewellery before limb swelling occurs, apply ice or a cool pack to the affected part to help reduce swelling. Continually monitor the patients condition
ASHICE (consider)
Transport to Hospital
Professional Handover