Lower Limb Fractures and Trauma

Hip fracture

What is a hip fracture?

If you have fractured your hip, you have broken the top of your thigh bone, most likely between the main part of the bone and the ball part of the hip socket joint. Sometimes the bones don’t separate after breaking, which makes the fracture hard to diagnose. This is called an occult (hidden) hip fracture.

Hip fractures are more common in older people, particularly those with osteoporosis. Some medications, balance problems and poor vision (leading to trips and falls) increase the risk of hip fractures.

A hip fracture is a very serious condition. It can cause you to be immobile for a long period of time, leading to complications such as blood clots, pneumonia, urinary tract infections, bed sore and loss of muscles. Around half of the people who have a hip fracture can’t return to independent living afterwards.

About one in 5 people who fracture their hip will have another hip fracture within 2 years.

What are the symptoms of hip fracture?

The symptoms of hip fracture are:

  • severe pain in your groin or front of your hip
  • being unable to bear weight on the affected leg
  • swelling, stiffness and bruising of your hip
  • the affected leg appearing shorter than the other one
  • being unable to get up after falling

What does your doctor look for?

Your doctor will take your medical history, including asking about how you hurt your hip, what other conditions you have, what medications you take and any previous fractures. Your doctor will also perform a physical examination that will include an assessment of whether you can bear weight on your leg and how your hip moves.

What investigations are needed?

Your doctor will often be able to tell that you have a hip fracture from your symptoms and physical examination. You will probably have an X-ray to confirm the fracture and show where the fracture is located.

Sometimes the fracture doesn’t show up on X-ray (eg occult fractures can be hard to see). In this case, you might need an MRI or bone scan to see the fracture.

How is a hip fracture treated?

Hip fractures are generally treated with surgery, in combination with medication and rehabilitation.

Hip fracture surgery

The type of surgery needed depends on the location and severity of the fracture, and on your general health and age. Options include:

  • repairing the fracture with metal screws to hold the broken parts together
  • partial hip replacement, where your surgeon removes the top of the thigh bone including the ball part of the hip socket joint and replaces this with a metal implant (prosthesis)
  • total hip replacement, where both the ball and the socket part of the hip joint are removed and replaced with prostheses

Rehabilitation starts soon after surgery (usually the next day) to help get you moving and shorten the length of time you are immobile.

Apart from pain medication, to reduce the risk of another hip fracture, medications called bisphosphates may also be prescribed.

Our specialists at Orthopaedic Clinics Gold Coast will work with you to create the best treatment plan for your particular situation.

Distal femoral fractures

What are distal femoral fractures?

A distal femoral fracture is break in the thighbone (femur) just above the knee. Distal femoral fractures occur due to:

  • weak bones (in older people)
  • a fall from a height
  • car/motor bike accidents

What are the symptoms of a distal femoral fracture?

Symptoms of a distal femoral fracture include:

  • pain, especially when trying to bear weight on the leg
  • swelling and bruising
  • deformity (eg the leg may be at an odd angle or appear shorter than the other)
  • inability to bear weight
  • inability to move your lower limb
  • numbness or tingling in your shin, ankle, foot or toes

What does your doctor look for?

Your doctor will ask about you about how the injury happened, about your symptoms and take a general medical history (eg pre-existing conditions such as osteoporosis, and previous injuries).

Your doctor will examine your leg looking for tenderness, swelling, deformity, movement and for signs of blood vessel or nerve damage.

How are distal femoral fractures treated?

Treatment depends on the severity of the fracture and on your general health and age, which affect your healing ability.

Some fractures will heal with conservative therapy. This typically involves stabilising the placing the leg in a cast or brace and taking pain medications. The cast or splint will usually be worn for 4–6 weeks.

Surgery is usually needed if the bones are displaced. During surgery, the bones are realigned and held together. The bones may be held together with internal pins or nails or screws and plates.

It can take many months of rehabilitation to return to normal activities after a distal femoral fracture.

Our specialists at Orthopaedic Clinics Gold Coast will work with you to create the best treatment plan for your particular situation.

Knee fractures and dislocations

What are knee fractures and dislocations?

A knee fracture is a break (or crack) in any of the parts of the bones that make up the knee joint: the femur (thighbone), the tibia (shin bone) and the patella (kneecap). Because of its location at the front of your knee, the kneecap is the most frequently fractures knee bone. The most common cause is a fall onto the kneecap.

Other parts of the knee may be fractured during car/motor bike accidents, jumping sports, falls from a height and when other injuries happen (eg ACL ligament rupture).

A knee dislocation is a rare injury where the bottom of the thighbone and the top of the shin bone come apart. Due to the strong supportive structures around the knee, this type of dislocation requires a lot of force. It tends to occur during a high-impact trauma such as car or motor bike accident or a severe fall. Note that a knee dislocation is not the same as a patella dislocation, which is a common injury.

What are the symptoms of knee fractures and dislocations?

Symptoms will vary with the location and severity of the fracture or dislocation. Dislocated bones often go back into place by themselves, but the injury tends to cause significant damage to soft tissues, meaning that symptoms remain. General symptoms include:

  • pain, especially when trying to straighten or stand on the leg
  • swelling and bruising
  • deformity
  • inability to bear weight or move the knee/lower leg

The knee may become very swollen if there is bleeding into and around the joint.

What does your doctor look for?

Your doctor will ask about you about how the injury happened, about your symptoms and take a general medical history (eg pre-existing conditions such as osteoporosis, and previous injuries).

Your doctor will also examine your leg looking for tenderness, swelling, deformity, movement and for signs of blood vessel or nerve damage.

What investigations are needed?

Your doctor will use The Ottawa knee rules to determine if you need an X-ray. For complex fractures or where more information is needed, your doctor may order a CT or MRI scan.

How are knee fractures and dislocations treated?

Treatment depends on the type and severity of your injury, as well as factors such as your age and general health.

The aims of any treatment are to realign the bones, stabilise the joint, preserve blood vessels and nerves and to control pain. Some injuries will be able to be treated conservatively, with casts or splints and pain medication. Other injuries will require surgical treatment.

Our specialists at Orthopaedic Clinics Gold Coast will work with you to create the best treatment plan for your particular situation.

Tibial and fibular fractures

What are tibial and fibular fractures?

Tibial and fibular fractures are breaks in the bones of the lower leg: the tibia and the fibula. Knee fractures are more common in children than in adults tibia (or shin bone) is the major bone in the lower leg and is the one that bears weight. Tibial fractures are typically caused by:

  • a fall onto the shin (tibial shaft)
  • a direct blow to the shin bone
  • violent twisting injuries (eg contact/impact sports)
  • intense training leading to a stress fracture (eg runners, ballet dancers)

The fibula is well covered by soft tissue, so tends to be protected from direct injury. The vast majority of fibular fractures occur at the same time as the tibial fracture. Fractures of just one of the two bones may occur in children.

Displaced tibial fractures are often complicated by blood vessel and nerve damage.

What are the symptoms of tibial and fibular fractures?

The symptoms of tibial and fibular fractures include:

  • severe pain immediately after the injury
  • swelling and bruising soon after the injury and can be severe due to damage to the soft tissues as well as the bones
  • deformity (eg the lower limb having an odd bend in it or appearing shorter than the other one)
  • inability to bear weight on the limb
  • weakness, numbness or tingling in the foot and toes

It is not uncommon for these fractures to be associated with broken bones poking through the skin. This is called a compound fracture.

Stress fractures may have more subtle signs because there is usually no displacement of the bones. Symptoms of stress fractures include pain initially after exercise and eventually all of the time. Warmth, swelling and pain just over the area of the fracture may occur.

What does your doctor look for?

Your doctor will ask you about how the injury occurred, about your symptoms and about your general health (eg pre-existing conditions, previous injuries).

Your doctor will examine your leg looking for pain, swelling, deformity and for signs of blood vessel and nerve damage.

What investigations are needed?

The diagnosis is usually obvious on physical examination, although stress fractures are much less obvious.

The most common investigation performed is an X-ray. A CT scan may be needed if X-rays aren’t able to confirm the diagnosis or if more information is required.

Bone scans and MRI scans tend to be better at picking up early stress fractures.

How are tibial and fibular fractures treated?

Treatment for these fractures depend on which bone is fractured, how severe the fracture, the degree of soft tissue damage and your age and general health.

Most cases in adults require surgery to realign the bones and hold them in place, typically with screws and metal plates. You will generally wear and cast for 6 weeks after the surgery, during which time you won’t be able to bear weight on the leg.

Prompt specialist treatment reduces the risk of complications such as serious/permanent blood vessel and nerve damage, infection and arthritis.

Our specialists at Orthopaedic Clinics Gold Coast will work with you to create the best treatment plan for your particular situation.

Ankle fractures

What is an ankle fracture?

An ankle fracture is a break (or crack) in one or more of the three bones that make up the ankle joint: the tibia, the fibula and the talus. The bony bump on the outside of your ankle is the end of the tibia and the one on the inside is the end of the fibula. The talus is the bone that joins the shin to the foot.

Ankle fractures may involve just the bones or they may involve the joints where bones meet.

Ankle fractures are usually caused by rolling or twisting the ankle during high impact jumping sports or falling.

What are the symptoms of an ankle fracture?

The symptoms of an ankle fracture are:

  • pain
  • swelling and bruising
  • deformity, which may be severe (eg the foot facing in the wrong direction)
  • inability to stand on the leg
  • inability to move the foot

In some cases, a piece of broken bone may poke out through the skin. This is called a compound fracture.

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What does your doctor look for?

Your doctor will ask you about how the injury occurred, about your symptoms and about your general health (eg pre-existing conditions, previous injuries).

Your doctor will examine your ankle looking for pain, swelling, deformity and for signs of blood vessel and nerve damage.

What investigations are needed?

Initial investigation usually involves an X-ray. Due to the complexity of the joint, you may need special X-rays with the ankle under some pressure or a CT scan. Where it is necessary to assess ligament damage, you might need an MRI scan.

How are ankle fractures treated?

Treatment depends on the location and severity of the fracture, as well as your age and general health, which affect your ability to heal.

If the bones are not displaced and the ankle is stable, conservative therapy may be used. This typically involves a cast or splint and pain medication. Surgical treatment is needed for unstable and displaced fractures. Surgery involves realigning the bones and holding them in place with screws and plates. Your ankle is then immobilised in a splint or cast.

You’ll need to keep weight off your ankle for some weeks. Most people manage with crutches, but some may need a wheelchair. Your doctor will also recommend physiotherapy to help restore strength and flexibility to the ankle.

Our specialists at Orthopaedic Clinics Gold Coast will work with you to create the best treatment plan for your particular situation.

What does your doctor look for?

Your doctor will ask you about how the injury occurred, about your symptoms and about your general health (eg pre-existing conditions, previous injuries).

Your doctor will examine your foot looking for pain, swelling, deformity and for signs of blood vessel and nerve damage.

What investigations are needed?

Depending on the location of the injury, your doctor will order an X-ray or CT scan. Where it is necessary to assess ligament damage, you might need an MRI scan.

How are foot and toe fractures treated?

Treatment depends on the location and severity of the fracture, as well as your age and general health, which affect your ability to heal.

If the bones are not displaced, conservative therapy may be used. This typically involves a cast or splint and pain medication. Surgical treatment is needed for unstable and displaced fractures. Surgery involves realigning the bones and holding them in place with screws and plates. Your foot is then immobilised in a splint or cast.

Our specialists at Orthopaedic Clinics Gold Coast will work with you to create the best treatment plan for your particular situation.