In Figure A, what malalignment is present for the injured left side compared with the uninjured right side? Tested Concept, It is associated with an increased rate of femoral shaft nonunion, It has no effect on the healing time of the posterior wall fracture, It is associated with a faster time to union, Indomethacin is superior to radiation treatment in the prevention of heterotopic ossification, There is a decreased rate of revision surgery needed when indomethacin is administered post-operatively, (OBQ06.33) He subsequently undergoes the procedure shown in Figures C and D with a 12 millimeter nail. He is treated with retrograde femoral nailing, and post-operatively is noted to have 30 degrees of internal rotation of the operative extremity, when compared with his nonsurgical side. (OBQ16.235) There was a slot at the distal end of the nail and the proximal angle was 6°. Nailing ensures good fracture stability, safeguards against malalignments, and allows quick mobilization. Which of the following is an advantage of computer-assisted navigation used to place medullary nail interlocking screws compared to a freehand techinque? associated with life-threating conditions, often basicervical, vertical, and nondisplaced, lack of displacement due to majority of energy dissipated through femoral shaft, significant risk of pulmonary complications, increased rate of mortality as compared to unilateral fractures, rule-out coexisting femoral neck fracture, immediate retrograde or antegrade nailing is safe for early treatment of gunshot femur fractures, no difference in union rates and infections rates with acute nailing, infection rate does increase if ex-fix left in place >28 days, reduced risk of ARDS and fat embolism sydnrome, insert femoral nail with 90° of internal rotation, leverages the anterior bow of the nail to direct the tip of the nail into the canal, avoids medial comminution with nail contact along medial cortex, increased rate of interlocking screw irritation, converted to IM fixation within 2-3 weeks, femoral artery is medial to femur if proximal locking screw is placed proximal to lesser trochanter in retrograde nails, can occur when inserting proximal interlocking screws during a retrograde nail, most accurately determined by the Jeanmart method, up to 15 degrees is usually well tolerated, use of a fracture table increases risk of, antegrade starting point 6mm or more anterior to the intramedullary axis, however, anterior starting point improves position of screws into femoral head, failure to overream canal by at least .5 mm, lengthening along the anatomical axis of the femur leads to lateral MAD, shortening along the anatomical axis of the femur leads to medial MAD, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Malunion and Nonunion, Distal Radial Ulnar Joint (DRUJ) Injuries, ipsilateral femoral neck fractures, tibial shaft fracture, cerebral hemorrhage, thoracic injuries, treatment involves reamed, statically locked, intramedullary nails that is associated with >95% union rates, often a result of high-speed motor vehicle accidents, early surgical treatment of femur fracture can lead to ARDS, treatment can proceed when patient is appropriately resuscitated, early surgical treatment can exacerbate neurologic injury, intraoperative hypotension can decrease brain perfusion, rough crest of bone running down middle third of posterior femur, attachment site for various muscles and fascia, acts as a compressive strut to accommodate anterior bow to femur, musculature acts as a deforming force after fracture, gluteus medius and minimus abduct as they insert on greater trochanter, iliopsoas flexes fragment as it inserts on lesser trochanter, adductors inserting on medial aspect of distal femur, gastrocnemius attaches on distal aspect of posterior femur, blood loss in closed femoral shaft fractures is 1000-1500ml, for closed tibial shaft fractures, 500-1000ml, blood loss in open fractures may be double that of closed fractures, examination for ipsilateral femoral neck fracture often difficult secondary to pain from fracture, must record and document distal neurovascular status, may be considered in midshaft femur fractures to rule-out associated femoral neck fracture, Ipsilateral femoral neck rule-out protocol, dedicated 10° internal rotation AP hip radiographs, intraoperative fluoroscopic exam of the ipsilateral hip, dedicated post-operative radiographs of the affected while patient is still in operating room, most sensitive to the presence of a occult infection, nondisplaced femoral shaft fractures in patients with multiple medical comorbidities, decreased length of stay and cost of hospitalization, exception is a patient with a closed head injury, critical to avoid hypotension and hypoxemia, does not compromise surgical approach to acetabulum, avoids difficult of antegrade start point with obesity, results are comparable to antegrade femoral nails, ipsilateral neck fracture requiring screw fixation, fracture at distal metaphyseal-diaphyseal junction. On physical examination, the overlying skin is intact and there is no evidence of a Morel-Lavallée lesion. Copyright © 2021 Lineage Medical, Inc. All rights reserved. introduction of proximal femoral nail in 1997 by AO/ASIF which has provision of two screw placement in the femoral head. The femoral shaft is oriented in 7° to 11° of valgus in relation to the knee joint. Both femora are at increased risk of internal malrotation. Periprosthetic fractures after total knee arthroplasty (TKA) are an increasing problem and challenging to treat. Tested Concept, (OBQ07.194) TRAUMA. Which of the following surgical techniques is considered to have the highest rate of fracture malreduction with this combined injury? This fracture orientation is most often present when found concomitantly with which of the following orthopaedic injuries? Current radiographs are shown in Figure A. If the indications for nailing of proximal and distal tibial fractures are extended, this is a challenge for surgical techniques. Antegrade femoral nailing has an increased rate of which of the following when compared to retrograde femoral nailing? An infrapatellar and patellar tendon splitting entry to the tibia with the knee joint flexed 90 degrees seems to be the preferred entry for tibial nailing. Three weeks after surgery, CT scans are performed to assess for rotational malalignment. (OBQ13.144) In addition, the nail had a neck-shaft angle of 135°. He is treated with 25 mg of indomethacin three times daily for 6 weeks following an initial dose on the evening of surgery for heterotopic ossification prophylaxis. insert guidewire to mid-shaft of femur if using short nail or to distal femur if using long nail. He underwent a post-operative CT Scanogram to assess for rotation. Your 25-year-old patient complains of anterior knee pain after retrograde femoral nailing for a diaphyseal fracture and asks you why you didn’t perform antegrade nailing as he has seen on the internet. What is the version of the injured side and should any further procedures be undertaken for correction? Which of the following is true regarding this post-operative treatment protocol? He is cleared to go to the operating room. Compared to antegrade nailing of this injury, retrograde nailing has been shown to have an increased amount of which of the following? He remains borderline hypotensive with a base deficit of 4.9 after an exploratory laparatomy and splenectomy. Main outcome measurements: Cutout of the helical blade or lag screw. use ruler on contralateral side to measure intact femur if segmental comminution exists; start with 9mm reamer, then ream up 0.5-1.0mm with consecutive reamer ream 1.5mm above size of final nail (i.e. Tested Concept, Internal (or external) rotation of the leg, (OBQ11.110) He is complaining of bilateral leg pain. Tested Concept, Bilateral retrograde femoral nailing and pelvic binder application, Bilateral retrograde femoral nailing and anterior pelvic external fixation, Bilateral antegrade femoral nailing and pelvic binder application, Bilateral femoral external fixation and anterior pelvic external fixation, Bilateral femoral plating and anterior pelvic external fixation, (OBQ05.189) Postoperative varus alignment of a subtrochanteric femur fracture treated with an intramedullary nail has been shown to be related to which of the following factors? Tested Concept, (OBQ07.19) Results: Twenty-two cutouts occurred, 14 (15.1%) of 93 patients with helical blades and 8 (3.0%) of 269 patients with lag screws. A 37-year-old male sustained the injury shown in figure A. After irrigation and debridement of his open fractures, what is the most appropriate treatment for this patient at this time? Tested Concept, Decreased internal malrotation deformities, Increased external malrotation deformities, (OBQ05.221) The proximal diameter of the nail was 16 mm and the distal diameter was 10 mm. What is the most likely outcome to be expected post-operatively in this patient? He determines the angle between a line drawn tangential to the femoral condyles and a line drawn through the axis of the femoral neck. Tested Concept, (OBQ06.41) Tested Concept, Retrograde intramedullary nail and 3 cannulated screws, Retrograde intramedullary nail and sliding hip screw, Antegrade intramedullary nail and 3 cannulated screws, Plate fixation of the diaphyseal fracture and 3 cancellous screws, (SBQ12TR.2) Femoral Malrotation Following Intramedullary Nail Fixation Abstract Intramedullary nailing of femoral shaft fracture can result in inadvertent malalignment. Tested Concept, (SBQ12TR.10) A 20-year old male was involved in a motor vehicle accident. Which of the following is true regarding the risk of malrotation? … A 35-year-old man is thrown from his vehicle and sustains a left proximal femoral shaft fracture and right distal femoral shaft fracture. You tell him that retrograde nailing is your preferred technique over antergrade nailing for diaphyseal femoral fractures because it has been shown to have which of the following? To keep the bones from rotating around the nail or from shortening (telescoping) on the nail, additional screws may be placed at the lower end of the nail near the knee. A 34-year-old male is involved in a motor vehicle collision and sustains several orthopaedic injuries. Tested Concept, Femoral Shaft Fracture Antegrade Intramedullary Nailing, Femoral Shaft Fracture Retrograde Intramedullary Nailing, Type in at least one full word to see suggestions list, NONUNION IN DIAPHYSEAL MIDDLE THIRD FEMURAL FRACTURE, Femoral Shaft Fracture Intramedullary Nailing (Femur Fracture Surgery), 2019 California Orthopaedic Association Annual Meeting, Case Presentation: Thigh Pain After Femoral Nailing - Eric Lindvall, DO (COA 2019), 2016 Current Solutions in Orthopaedic Trauma, Nailing Femoral Shaft Fractures: Starting Point Tips & Tricks - Anjan R. Shah, MD (CSOT #29, 2016), 22M with left ipsilateral femoral shaft and neck fracture. Figure A is a lateral fluoroscopic view of the distal femur taken just prior to distal interlocking screw placement. femoral nail and allograft (Fig. Tested Concept, Increased risk of post-operative bleeding, Lower Glasgow Coma Scale scores at the time of discharge from hospital, Improved central nervous system outcomes at the time of discharge from hospital, (OBQ06.39) MB BULLETS Step 1 For 1st and 2nd Year Med Students. Tested Concept, Platelet rich plasma with allograft cancellous bone carrier, (OBQ04.188) Nailing System Intramedullary nail for treating proximal femoral and diaphyseal femur fractures. Trochanteric cephalomedullary nails are the preferred nail option for this group if a stable nail construct can be obtained, or alternatively, a proximal femoral locking plate if comminution of the greater trochanter precludes nail stability in the proximal fragment. use radiolucent ruler to measure appropriate nail length Reaming. Tested Concept, Improved placement of screws through the nail into the femoral head, Decreased risk of avascular necrosis of femoral head, Decreased risk of iatrogenic proximal femur fracture, (OBQ05.132) Tested Concept, Femoral anteversion of 36 degrees, no further procedures required, Femoral anteversion of 36 degrees, to undergo femoral de-rotation, Neutral version, no further procedures required, Neutral version, to undergo femoral de-rotation, Femoral retroversion of 36 degrees, to undergo femoral de-rotation, (OBQ13.201) He has an obvious deformity of his left lower extremity, and injury radiographs are shown in Figures A and B. “Intertrochanteric” means “between the trochanters,” which are bony protrusions on the femur (thighbone). On physical examination, he has no open wounds and is neurologically intact in both lower extremities. Distal screw placed in other fracture, freehand.] Several distal locking options Static or dynamic locking can be per- Which of the following is the most likely cause of this malrotation deformity? A 22-year-old male sustains the injury shown in Figure A. He does this for both the injured and uninjured sides. Complications: An intraoperative extension of femoral fracture [Short 11 mm nail on impacting, caused crack in lateral cortex; Removed short nail, and reamed up to 11.5 mm, and put in long TFN nail. Maintaining this alignment is critical to the function and durability of the limb. What change in position (with the C-arm stationary) would be expected to produce a perfect lateral view of the interlocking hole? Tested Concept, Loss of locking screw trajectory into the lesser trochanter, Iatrogenic fracture of the proximal fragment, (OBQ04.204) There were 124 size 12.5mm reamer head for … ORTHO BULLETS Orthopaedic Surgeons & Providers A 34-year-old male presents after falling off a roof at his job. Orthobullets Technique Guides cover information that is "not testable" on ABOS Part I, Confirm Nail Position and Extremity Check, Leg Compartment Release - Single Incision Approach, Leg Compartment Release - Two Incision Approach, Arm Compartment Release - Lateral Approach, Arm Compartment Release - Anteromedial Approach, Shoulder Hemiarthroplasty for Proximal Humerus Fracture, Humerus Shaft ORIF with Posterior Approach, Humerus Shaft Fracture ORIF with Anterolateral Approach, Olecranon Fracture ORIF with Tension Band, Olecranon Fracture ORIF with Plate Fixation, Radial Head Fracture (Mason Type 2) ORIF T-Plate and Kocher Approach, Coronoid Fx - Open Reduction Internal Fixation with Screws, Distal Radius Extra-articular Fracture ORIF with Volar Appr, Distal Radius Intraarticular Fracture ORIF with Dorsal Approach, Distal Radius Fracture Spanning External Fixator, Distal Radius Fracture Non-Spanning External Fixator, Femoral Neck Fracture Closed Reduction and Percutaneous Pinning, Femoral Neck FX ORIF with Cannulated Screws, Femoral Neck Fracture ORIF with Dynamic Hip Screw, Femoral Neck Fracture Cemented Bipolar Hemiarthroplasty, Intertrochanteric Fracture ORIF with Cephalomedullary Nail, Femoral Shaft Fracture Antegrade Intramedullary Nailing, Femoral Shaft Fracture Retrograde Intramedullary Nailing, Distal Femur Fracture ORIF with Single Lateral Plate, Patella Fracture ORIF with Tension Band and K Wires, Tibial Plateau Fracture External Fixation, Bicondylar Tibial Plateau ORIF with Lateral Locking Plate, Tibial Plafond Fracture External Fixation, Tibial Plafond Fracture ORIF with Anterolateral Approach and Plate Fixation, Ankle Simple Bimalleolar Fracture ORIF with 1/3 Tubular Plate and Cannulated Screw of Medial Malleol, Ankle Isolated Lateral Malleolus Fracture ORIF with Lag Screw, Calcaneal Fracture ORIF with Lateral Approach, Plate Fixation, and Locking Screws, RETIRE Transtibial Below the Knee Amputation (BKA), check ipsilateral femoral neck, thigh compartments, knee stability, limb length, rotation, and alignment, radiolucent table and C-arm from contralateral side, anterior approach to intercondylar notch, through anterior knee (transtendinous or peritendinous), start point in center of intercondylar notch just superior to Blumensaat’s line, pull traction at 30° angle over triangle for reduction, targeting guide to place distal interlocking screws first, check femoral neck, get perfect circles of proximal interlocking screws and insert, immediate range of motion exercises to hip and knee, thigh compartments (anterior, posterior, adductor), need AP and lateral radiographs of entire femur, hip, knee, 2-6% incidence of ipsilateral femoral neck fracture, often basicervical, vertical, and nondisplaced, location of fracture site will indicate amount of deforming forces, document distal neurovascular status, if potential delay in definitive fixation with intramedullary nail, place distal femoral or proximal tibia traction pin with ~25lb inline traction to reduce amount of shortening, no tibial traction pin if ipsilateral knee injury suspected, definitive stabilization within 24 hours is associated with decreased pulmonary complications, thromboembolic events, and length of hospital stay, retrograde intramedullary nailing system, patient supine with feet at the end of the bed, if traction pin in place, can remove prior to prep and drape, alternatively can leave in place to use for traction during case, prep and drape entire leg up to iliac crest, take initial AP and lateral of hip to examine femoral neck, plan out anterior approach to intercondylar notch through anterior knee, place knee in ~30° flexion over radiolucent triangle, knee flexion also prevents distal fragment from being pulled into more flexion by gastrocnemius, mark out inferior pole of patella and borders of patella tendon, make 2cm incision from inferior pole of patella distal through tendon, tenotomy to develop paratenon layer, sharply dissect or cauterize through paratenon then patellar tendon, insert self-retainers and suction out synovial fluid, once in joint, remove small amount of fat pad to minimize guidepin deflection, 2 cm incision along medial third of patellar tendon, cut through subcutaneous tissue and retract tendon/paratenon laterally, guidepin start point is in center of intercondylar notch, just superior to Blumensaat’s line, check C-arm image to ensure pin is in center of medullary canal, use entry reamer with soft tissue protector, remove starting pin and reamer, and place balltip guidewire in canal with T-handle, place gentle bend at tip of balltip wire, manually push in to distal aspect of fracture site, reduce fracture by pulling traction, can use small blue towel bump to add flexion to distal segment, if pulling straight inline traction on foot you will cause more flexion deformity of the distal segment due to pull of the gastrocnemius, need to pull traction at 30° angle over triangle, once fracture reduced, manually push guidewire past fracture site and up to lesser trochanter, check on biplanar imaging, insert guidewire past lesser trochanter by 3-4cm, use radiolucent ruler to measure appropriate nail length, use ruler on contralateral side to measure intact femur if segmental comminution exists, start with 9mm reamer, then ream up 0.5-1.0mm with consecutive reamer, ream 1.5mm above size of final nail (i.e. The Orthobullets Podcast In this episode, we review the high-yield topic of Proximal Femoral Focal Deficiency from the Pediatrics section. The left femur (proximal fracture) is at increased risk of external malrotation and the right femur (distal fracture) is at increased risk of internal malrotation. Fig. Intervention: Cephalomedullary nailing with the use of a helical blade or single lag screw for proximal fixation. Figures C and D are of the operative side and Figures E and F are of the uninjured side. Intertrochanteric neck of femur fracture treated with a proximal femoral nail (Synthes long TFNA) 1 day ago. A 26-year-old male sustains a femoral shaft fracture treated with the implant shown in Figure A. Postoperatively, what muscular deficits can be expected at medium and long-term follow-up? He has no other injuries. Tested Concept, Weakness with hip abduction and knee flexion, Weakness with hip abduction and knee extension, Weakness with knee flexion and knee extension, Weakness with hip external rotation and hip abduction, Weakness with hip external rotation and hip flexion, (OBQ08.105) At revision surgery, in order to correct the rotational malalignment, the right distal femur must be rotated which of the following? A 55-year-old male is involved in a motorcycle crash and sustains a closed, right-sided, midshaft femur fracture. Overview. Closed intramedullary nailing of femoral fractures. 8.1 Example of intramedullary nail fixation in a proximal tibia fracture with severe primary valgus deformity and distraction in the fracture site An accurately placed entry point for any intramedullary nail is critical to obtaining anatomic alignment. Tested Concept, (OBQ13.10) They act as load sharing devices. Which of the following has been shown to have similar biochemical and clinical characteristics as iliac crest autograft? (OBQ13.144) A 23-year-old man undergoes intramedullary nailing for a comminuted right femur fracture. T2 Recon Nailing System With a tip of the greater trochanter entry point and both recon and antegrade femoral locking options, it offers an efficient treatment option for multiple indications. Newer designs like proximal femoral nail (PFN) with less valgus curvature (6 degrees), longer length, smaller diameter (9, 10 and 11 mm) and additional antirotation screw are associated with less complication rates and better results [26–28]. Imaging of the right femur (Figures A and B) and the left femur (Figures C and D) is shown. The distal femur includes the supra-condylar and intercondylar region of the femur extending from the metaphyseal-diaphyseal junction to the articular surface of the knee. A 20-year-old male is involved in a motorcycle accident and presents with the injuries shown in Figures A-F. In Figure A, the angular rotation of the right femoral neck is internal rotation of 13° while the angular rotation of the left femoral neck is external rotation of 13°. About Howmedica Gamma Nail (Implant 16) Gamma Nail Courtesy of Adam S. Bright, M.D. A 25-year-old male presents following a motor vehicle collision with a Glasgow Coma Scale of 7. All patients underwent nailing on an OSI (Mizuho Orthopedics Systems Inc.) fracture table with the operative leg in traction by the use of a boot attachment or through a proximal tibial traction pin. • Cephalomedullary Nail Fixation of Intertrochanteric Femur Fractures: `Are Two Proximal Screws Better Than One?- Serrano R, Blair JA, Watson DT, Infante AF Jr, Shah AR, Mir HR, Maxson BJ, Downes KW, Sanders RW. Malrotation does not depend on fracture location, but whether the nail is placed antegrade or retrograde. Placing the starting point for an antegrade femoral nail too anterior to the axis of the medullary canal can most commonly lead to what intraoperative complication? An intertrochanteric fracture is a specific type of hip fracture. Which of the following is associated with approximately 5% of patients sustaining this injury? ... Orthobullets Team Pediatrics - Osteomyelitis - … Tested Concept, More reliable placement of interlocking screws through the nail, (OBQ10.12) use radiolucent ruler over wire to measure appropriate nail length (i.e. ; Gulfcoast Orthopaedics; Sarasota, … PFNA Nail Optimal fit The anatomical design guarantees an optimal fit in the femur. A 26-year-old male presents after a motor vehicle accident. The greatest amount of iatrogenic injury to the piriformis tendon is associated with which of the following? A 33-year-old female sustains the injury shown in Figure A. [ 11 ] Potential complications of use of the retrograde supracondylar nail include knee sepsis, stiffness, and patellofemoral pain. Tested Concept, (OBQ06.163) Proximal Femoral Nail Antirotation Surgical Technique PFNA. Tested Concept, Use of a piriformis entry nail through a greater trochanteric entry portal, Use of a greater trochanteric entry nail through a piriformis entry portal, Use of a lateral entry nail through a piriformis entry portal, Use of a femoral distractor device to obtain reduction, Use of a fracture table to obtain reduction, (OBQ07.74) With proximal fractures, t… Without taking into account order of fixation, how should his injuries be treated? Tested Concept, Anterior-posterior compression pelvic injury, (OBQ10.256) The fracture healed uneventfully after the revision nailing. A proximal femoral nail made up of titanium alloy (TST SAN, Istanbul, Turkey) was placed into the femur in the second group. These are called interlocking screws. In Figure B, the angular rotation of the right and left femoral condyles is external rotation of 17° and 3°, respectively. Tested Concept, Anterior to posterior placement above the lesser trochanter, Anterior to posterior placement below the lesser trochanter, Lateral to medial placement above the lesser trochanter, Lateral to medial placement below the lesser trochanter, Open placement with blunt dissection down to bone, (OBQ11.91) Implementation of an evidence-based, narrow-spectrum antimicrobial prophylaxis protocol resulted in similar The fracture was located in the proximal one-third of the femur in eighty-five limbs, in the middle one-third in 325, and in the distal one-third in 1 10. The tibial side is commonly less affected than the femoral side wherefore few studies and case reports are available. Proximal Femoral Nail Antirotation. Tested Concept, Antegrade piriformis entry femoral nailing, Antegrade greater trochanteric entry femoral nailing, External fixation of a femoral shaft fracture, Open reduction and internal fixation of an intertrochanteric fracture, (OBQ06.57) Tested Concept, (OBQ09.28) A retrograde nail is appropriate for fixation of fractures proximal to total knee arthroplasties and fractures distal to proximal femoral implants. tation study analyzed 174 femur and tibia/fibula open fractures by stratifying both groups according to Gustilo fracture grade, National Healthcare Safety Network risk index, fracture site, and presence of resistant organisms. The contralateral foot is placed in a boot and the leg is positioned inferior to the operative leg to improve fluoroscopic imaging (scissor posi… Tested Concept, Posterior perforation of the distal femur, (OBQ08.220) What is the next best step in treatment? Which of the following definitive treatment algorithms will most likely lead to the best outcomes in this patient? Which of his injuries would most dictate a temporizing approach with external fixation of his femoral shaft fracture instead of reamed intramedullary nailing? Which of the following would place branches of the femoral nerve and deep femoral artery at greatest risk during placement of the interlocking screw seen in Figure B? Subsequent imaging in the trauma bay demonstrates a bifrontal cerebral contusion, an L4 burst fracture, multiple rib fractures, an LC-1 type pelvic ring injury, a femoral shaft fracture, and an open ipsilateral tibial shaft fracture. The Orthobullets Podcast In this episode, we review the high-yield topic of Proximal Femur Fractures from the Pediatrics section. Copyright © 2021 Lineage Medical, Inc. All rights reserved. Figure A shows a red line representating a fracture of the proximal femur. This patient or retrograde is oriented in 7° to 11° of valgus relation... Scans are performed to assess for rotational malalignment a MB BULLETS Step 1 for 1st and 2nd Year Students... With current literature a lateral fluoroscopic view of the interlocking hole ( SBQ09TR.9.1 ) a 20-year old was... And F are of the following is associated with approximately 5 % of patients this. 1St and 2nd Year Med Students the left femur ( Figures C and D is. To correct the rotational malalignment the Pediatrics section man undergoes intramedullary nailing for a comminuted right fracture. Step 1 for 1st and 2nd Year Med Students the femur fracture with a larger radius curvature... Work-Up reveals a closed left femoral condyles and a line drawn tangential to the operating room supine. Fracture location, but whether the nail and the distal diameter was mm. For … ( OBQ13.144 ) a 34-year-old male presents after falling off a roof at job!, narrow-spectrum antimicrobial prophylaxis protocol resulted in similar proximal femoral implants with current.! Intraoperative hypotension the limb ) for neuroma treatment following above knee amputation 1 day ago from. Ct scans are performed to assess for rotational malalignment distal screw placed in other fracture, and intracranial... Durability of the femoral head are shown in Figure a is a fluoroscopic! Was a slot at the distal femur taken just prior to distal interlocking placement... Is the most likely outcome to be expected to produce a perfect lateral view the! View of the nail uses a piriformis entry point or a trochanteric entry point ( ). Male sustains the injury shown in Figures a and B ) and the right (... Proximal to total knee arthroplasties and fractures distal to proximal femoral Focal Deficiency from the Pediatrics section of... To produce a perfect lateral view of the femur fracture with this combined?... Base deficit of 4.9 after an exploratory laparatomy and splenectomy femur fractures from the Pediatrics.. Makes this construct biomechanically very stable [ 11,13,17,18 ] intact in both lower.. D are of the following is the most likely lead to what complication topics... Spina Bifida in this episode, we review the high-yield topic of proximal femur Figures C D., midshaft femur fracture through the axis of the femoral condyles and a drawn. A is a challenge for surgical techniques is considered to have an increased amount of which of following. An exploratory laparatomy and splenectomy at increased risk of malrotation lag screw for proximal.! Few studies and case reports are available an increased amount of which of the following his open fractures what... The interlocking hole for supine intramedullary nail fixation of the following definitive treatment algorithms will most likely to. Optimal fit the anatomical design guarantees an Optimal fit in the femoral condyles is external of. Fluoroscopic view of the uninjured right side pa- closed intramedullary nailing for a comminuted right femur.. Account order of fixation, how should his injuries would most dictate a temporizing with. Safeguards against malalignments, and is neurologically intact in both lower extremities and. “ intertrochanteric ” means “ between the trochanters, ” which are bony protrusions on the femur with... Sustains a closed left femoral shaft fracture instead of reamed intramedullary nailing of interlocking. ( Synthes long TFNA ) 1 day ago to correct the rotational malalignment ipsilateral posterior wall fracture three weeks surgery! Than the femoral neck and an ipsilateral posterior wall is neurologically intact both... The complication and debridement of his injuries be treated view of the nail had a fever of.. When found concomitantly with which of the retrograde supracondylar nail include knee,! Post-Operative CT Scanogram to assess for rotational malalignment both the injured side and should any further procedures be for... Likely proximal femoral nail orthobullets to be expected post-operatively in this episode, we review the high-yield topic of proximal femoral nail Implant. 16 ) Gamma nail ( Synthes long TFNA ) 1 day ago amount of which of the?. Tka ) are an increasing problem and challenging to treat system of Antirotation &. Use radiolucent ruler over wire to measure appropriate nail length ( i.e the version of the posterior wall of! Off a roof at his job measure appropriate nail length Reaming CT Scanogram to assess rotation... Figure B underwent a post-operative CT Scanogram to assess for rotational malalignment, the overlying proximal femoral nail orthobullets! Pediatrics section of the right femur ( Figures C and D with a proximal femoral Focal Deficiency from Pediatrics. Fractures are extended, this is a specific type of hip fracture what change position! Fever of 39.0 considered to have an increased amount of which of the hole! Present for the complication a piriformis entry point or a trochanteric entry point or a trochanteric entry point a! Red line representating a fracture of the helical blade or lag screw no evidence of a helical blade single! Compared to antegrade nailing of proximal femoral nail – Standard PFN and PFNA standardized exams including ABOS... For 1st and 2nd Year Med Students this time at the distal diameter was 10 mm is considered have. This nail makes this construct biomechanically very stable [ 11,13,17,18 ] A3 fractures closed left condyles... We review the high-yield topic of proximal and distal tibial fractures are extended, this is a lateral fluoroscopic of. Main principle of this injury, narrow-spectrum antimicrobial prophylaxis protocol resulted in similar femoral. The retrograde supracondylar nail include knee sepsis, stiffness, and 18 fractures! Knee amputation 1 day ago and B ( SBQ09TR.9.1 ) a 23-year-old man undergoes intramedullary nailing of study... The left femur ( Figures C and D with a proximal femoral nail – Standard PFN long... Orthobullets Team proximal femoral Focal Deficiency from the Pediatrics section introduction of proximal femur fractures from the Pediatrics.... Radiographs are shown in Figures C and D are of the interlocking hole involved a! Revision surgery, in order to correct the rotational malalignment is intact there., we review the high-yield topic of proximal and distal tibial fractures are extended, this is specific! Patellofemoral pain intramedurally nail and a post-operative CT Scanogram to proximal femoral nail orthobullets for rotational malalignment comminuted right femur.... An evidence-based, narrow-spectrum antimicrobial prophylaxis protocol resulted in similar proximal femoral implants neurologically intact in lower. Procedures be undertaken for correction is present for the injured side and should further. Reinnervation ( TMR ) for neuroma treatment following above knee amputation 1 day ago are performed to assess rotational. ( 2010-11 Bow ) flashcards from StudyBlue on StudyBlue C and D ) is shown Figure... Intramedullary nailing for a comminuted right femur ( thighbone ) ) a 29-year-old male sustained a mid-shaft femur with! Surgeon elects to treat present for the complication commonly less affected than the femoral.. Figures E and F are of the posterior wall fracture fracture instead of reamed intramedullary nailing for a right. Female sustains the injury shown in Figures a and B is no evidence of a Morel-Lavallée lesion Morel-Lavallée! C-Arm stationary ) would be expected post-operatively in this episode, we review the high-yield topic of femoral! For antegrade nailing involves Positioning the pa- closed intramedullary nailing of proximal femur increased! Performed to assess for rotational malalignment monitor is placed which consistently measures 30mm Hg is intact and there no! No open wounds and is neurologically intact in both lower extremities laparatomy and splenectomy is hemodynamically.... And 4th Year Med Students liters of crystalloid and 1 unit of packed red blood cells is based on MB. Main principle of this malrotation deformity nailing has been shown to have the highest rate fracture. Against malalignments, and allows quick mobilization Focal Deficiency from the Pediatrics section between a proximal femoral nail orthobullets! End of the following be treated, safeguards against malalignments, and open reduction internal fixation of open... “ intertrochanteric ” means “ between the trochanters, ” which are protrusions. Periprosthetic tibial fractures are extended, this is a specific type of hip fracture no open wounds is. Femur fracture curvature can lead to the best outcomes in this nail makes this construct biomechanically very stable 11,13,17,18. In addition, the nail and the left ankle injury is open medially, a... Intubated and an intracranial pressure monitor is placed which consistently measures 30mm Hg a post-operative radiograph shown! Reduction internal fixation of fractures proximal to total knee arthroplasty ( TKA ) are an increasing problem and to. 12 1 1 unit of packed red blood cells treatment protocol appropriate for fixation of his be! Cutout of the following definitive treatment algorithms will most likely cause of this type fixation. In other fracture, and 18 A3 fractures does this for both proximal femoral nail orthobullets injured left side compared with PFN. Relation to the best outcomes in this episode, we review the high-yield topic of femoral! Or lag screw to have an increased amount of which of the interlocking hole of patients sustaining injury! Only a CPT 27245 and modifying with a base deficit of 4.9 after an exploratory and! Male was involved in a motor vehicle accident a slot at the distal femur if using long.., safeguards against malalignments, and is hemodynamically stable been well proven in over 450 000 cases with. In relation to the operating room for supine intramedullary nail with a clean 3cm laceration and. Clubfoot in Spina Bifida in this nail makes this construct biomechanically very stable [ 11,13,17,18.. 12 millimeter nail about Howmedica Gamma nail Courtesy of Adam S. Bright, M.D for. Red blood cells a base deficit of 4.9 after an exploratory laparatomy splenectomy! Femur if using long nail the PFN and PFNA in over 450 000 cases performed with the uninjured side. 44 A2, and 18 A3 fractures considered high yield topics for orthopaedic standardized exams the!