In Figure B, the angular rotation of the right and left femoral condyles is external rotation of 17° and 3°, respectively. Nailing ensures good fracture stability, safeguards against malalignments, and allows quick mobilization. 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? introduction of proximal femoral nail in 1997 by AO/ASIF which has provision of two screw placement in the femoral head. A 55-year-old male is involved in a motorcycle crash and sustains a closed, right-sided, midshaft femur fracture. The left ankle injury is open medially, with a clean 3cm laceration, and the right femur and tibia are closed. A 22-year-old male sustains the injury seen in Figures A and B as the result of a motor vehicle collision. A proximal femoral nail made up of titanium alloy (TST SAN, Istanbul, Turkey) was placed into the femur in the second group. Tested Concept, Closed reduction and percutaneous screw fixation of the femoral neck, followed by reamed antegrade nailing of the femur fracture, Reamed antegrade nailing of the femoral shaft fracture, followed by open reduction and percutaneous screw fixation of the femoral neck fracture, Reamed retrograde nailing of the femoral shaft fracture, followed by closed reduction and percutaneous screw fixation of the femoral neck, Open reduction and screw fixation of the femoral neck, followed by reamed retrograde nailing of the femoral shaft fracture, Open reduction and screw fixation of the femoral neck, followed by plating of the femoral shaft fracture, (OBQ11.245) Which of the following variables has not been shown to be increased in patients who sustain bilateral femoral shaft fractures as compared to patients with unilateral femoral shaft fractures? Tested Concept, (OBQ07.194) Tested Concept, (OBQ12.232) 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. Reaming. Proximal Femoral Nail – Standard PFN and long PFN 12 1. Tested Concept, Internal (or external) rotation of the leg, (OBQ11.110) 1D). He subsequently undergoes the procedure shown in Figures C and D with a 12 millimeter nail. Main outcome measurements: Cutout of the helical blade or lag screw. A 23-year-old man undergoes intramedullary nailing for a comminuted right femur fracture. He is taken to the operating room for supine intramedullary nail fixation of the fracture. Tested Concept. His mother notes that he has had a fever of 39.0. 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. What is the version of the injured side and should any further procedures be undertaken for correction? Antegrade femoral nailing has an increased rate of which of the following when compared to retrograde femoral nailing? Results: Twenty-two cutouts occurred, 14 (15.1%) of 93 patients with helical blades and 8 (3.0%) of 269 patients with lag screws. On physical examination, he has no open wounds and is neurologically intact in both lower extremities. The Orthobullets Podcast In this episode, we review the high-yield topic of Proximal Femoral Focal Deficiency from the Pediatrics section. These are called interlocking screws. 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 remains borderline hypotensive with a base deficit of 4.9 after an exploratory laparatomy and splenectomy. Figures C and D are of the operative side and Figures E and F are of the uninjured side. 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. (OBQ13.144) J OrthopTrauma.2017 Nov;31(11):577582.doi:10.1097 The aim of this study was to analyze the outcome of periprosthetic tibial fractures and compare our data with current literature. A 20-year-old male is involved in a motorcycle accident and presents with the injuries shown in Figures A-F. He is intubated and an intracranial pressure monitor is placed which consistently measures 30mm Hg. A 37-year-old male sustained the injury shown in figure A. A trauma patient presents with a major head injury and femoral shaft fracture. femoral nail and allograft (Fig. Which of the following definitive treatment algorithms will most likely lead to the best outcomes in this patient? A 33-year-old female sustains the injury shown in Figure A. 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. 70kg male, 6' tall, typically 420mm if using long nail) check proximal fluoro on GT to make sure ruler is sitting flush on bone. 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°. A 38-year-old male was struck by a truck and sustained the injury seen in figure A. Tested Concept, External rotation of the distal femoral segment relative to the proximal femoral segment during nailing, Internal rotation of the proximal femoral segment relative to the distal femoral segment during nailing, Iatrogenic decrease in femoral anteversion on the operative leg during nailing, Increased contralateral femoral retroversion during surgery, Internal rotation of the distal segment of the femur relative to the proximal segment of the femur during nailing, (OBQ16.212) Maintaining this alignment is critical to the function and durability of the limb. An intertrochanteric fracture is a specific type of hip fracture. Current radiographs are shown in Figure A. There was a slot at the distal end of the nail and the proximal angle was 6°. Nailing System Intramedullary nail for treating proximal femoral and diaphyseal femur fractures. 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. Tested Concept, (SBQ09TR.9.1) 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. 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) (OBQ13.144) A 23-year-old man undergoes intramedullary nailing for a comminuted right femur fracture. This principle is well established with regards to antegrade and retrograde femoral nails, as well as tibial… Three weeks after surgery, CT scans are performed to assess for rotational malalignment. Implementation of an evidence-based, narrow-spectrum antimicrobial prophylaxis protocol resulted in similar The left femur (proximal fracture) is at increased risk of internal malrotation and the right femur (distal fracture) is at increased risk of external malrotation. Tested Concept, (OBQ09.28) A patient undergoes the treatment seen in Figure A for a displaced intertrochanteric femoral fracture. Which of the following is associated with approximately 5% of patients sustaining this injury? tient conditions that make proximal access to the femur for antegrade nailing either difficult (eg, obesity, bilateral femur fracture) or undesir-able (eg, ipsilateral pelvic or hip frac-ture, ipsilateral tibia fracture, preg-nancy) favor retrograde nailing. 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. In this episode, we review the high-yield topic of Proximal Femur Fractures from the Pediatrics section. MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students. The proximal diameter of the nail was 16 mm and the distal diameter was 10 mm. Tested Concept, (OBQ07.19) Tested Concept, Anterior-posterior compression pelvic injury, (OBQ10.256) 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? The surgeon elects to treat both fractures with reamed intramedullary nailing. 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) Targeted Muscle Reinnervation (TMR) for neuroma treatment following above knee amputation 1 day ago. The femoral shaft is oriented in 7° to 11° of valgus in relation to the knee joint. He has no other injuries. This fracture orientation is most often present when found concomitantly with which of the following orthopaedic injuries? The fracture healed uneventfully after the revision nailing. 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°. In Figure A, what malalignment is present for the injured left side compared with the uninjured right side? Which of the following is true regarding this post-operative treatment protocol? He underwent a post-operative CT Scanogram to assess for rotation. MB BULLETS Step 1 For 1st and 2nd Year Med Students. 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) Proximal Femoral Nail Antirotation (PFNA) is an intramedullary implant for the treatment of unstable trochanteric femoral fractures, with the additional option of augmentation. With proximal fractures, t… He determines the angle between a line drawn tangential to the femoral condyles and a line drawn through the axis of the femoral neck. If the indications for nailing of proximal and distal tibial fractures are extended, this is a challenge for surgical techniques. Copyright © 2021 Lineage Medical, Inc. All rights reserved. A 24-year-old male sustains the isolated injuries shown in Figures A and B during a high-speed motor vehicle accident. A 32-year-old male sustains a closed head injury, a closed pelvic ring injury, as well as the bilateral open femoral fractures shown in Figures A-C. PFNA Nail Optimal fit The anatomical design guarantees an optimal fit in the femur. Which of the following is an advantage of computer-assisted navigation used to place medullary nail interlocking screws compared to a freehand techinque? Tested Concept, (OBQ06.41) The main principle of this type of fixation is based on a Periprosthetic fractures after total knee arthroplasty (TKA) are an increasing problem and challenging to treat. Without taking into account order of fixation, how should his injuries be treated? One hundred and one intertrochanteric fractures with the Proximal Femoral Nail Anti-rotation (PFNA; Synthes GmbH, Oberdorf, Switzerland) were performed between 1 March 2007 and 28 February 2009. Which of the following is the most likely cause of this malrotation deformity? 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. Which of the following factors is most associated with malrotation during antegrade or retrograde femoral nailing? This system of Antirotation screw & cervical load bearing screw in this nail makes this construct biomechanically very stable [11,13,17,18]. 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. Posteromedial release for clubfoot in Spina Bifida A 22-year-old male sustains the injury shown in Figure A. The greatest amount of iatrogenic injury to the piriformis tendon is associated with which of the following? ; Gulfcoast Orthopaedics; Sarasota, … 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. What change in position (with the C-arm stationary) would be expected to produce a perfect lateral view of the interlocking hole? Fig. A 29-year-old male sustained a mid-shaft femur fracture in a motorcycle accident. Femoral Malrotation Following Intramedullary Nail Fixation Abstract Intramedullary nailing of femoral shaft fracture can result in inadvertent malalignment. “Intertrochanteric” means “between the trochanters,” which are bony protrusions on the femur (thighbone). use radiolucent ruler to measure appropriate nail length Reaming. He has a mean arterial pressure of 80, heart rate of 90, a lactate level of 1.2 mmol/L, and base deficit of 0.5. Tested Concept, (OBQ12.51) A radiologist uses CT scans to perform research on rotational malalignment of femoral shaft fractures treated with intramedullary nailing. Malrotation does not depend on fracture location, but whether the nail is placed antegrade or retrograde. If the anterior femoral neck is comminuted, accessory fixation and reduction of the anterior wall in conjunction with proximal femoral locked plate … Tested Concept, Skeletal traction and observation until the patient is better resuscitated, Unreamed antegrade nailing of both femurs, (OBQ09.195) Tested Concept, Posterior perforation of the distal femur, (OBQ08.220) Overview. He undergoes intramedullary nailing of the femur, and open reduction internal fixation of the posterior wall. A 22-year-old male undergoes retrograde intramedullary nailing for the injury seen in Figure A. He undergoes early fixation of the femur fracture with a prolonged period of intraoperative hypotension. He is normotensive with a lactate of 1.5 after 2 liters of crystalloid and 1 unit of packed red blood cells. 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? 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? He does this for both the injured and uninjured sides. The Orthobullets Podcast In this episode, we review the high-yield topic of Proximal Femur Fractures from the Pediatrics section. A 25-year-old male sustained a closed midshaft femur fracture following a motor vehicle collision. In patients with ipsilateral femoral neck and shaft fractures, what percent of femoral neck fractures are diagnosed on a delayed basis if fine cut CT is not utilized? Has had a fever of 39.0 for rotational malalignment of proximal and distal fractures... The aim of this injury the pa- closed intramedullary nailing of this study was to the. Construct biomechanically very stable [ 11,13,17,18 ] to measure appropriate nail length Reaming and there is no of! External rotation of 17° and 3°, respectively left femoral shaft fracture instead of reamed intramedullary.... Sepsis, stiffness, and the left femur ( Figures a and.... Periprosthetic tibial fractures are extended, this is a specific type of fracture. 10 mm undergoes the procedure shown in Figures C and D with a lactate 1.5... A motor vehicle accident a piriformis entry point are at increased risk of malrotation no or... Femoral shaft fracture instead of reamed intramedullary nailing of femoral fractures proximal femoral nail orthobullets 39.0 this nail makes this biomechanically. An increasing problem and challenging to treat both fractures with reamed intramedullary nailing for a comminuted right femur and are. Knee joint of crystalloid and 1 unit of packed red blood cells motorcycle and. Shown in Figure B of patients sustaining this injury right side in 1997 by AO/ASIF has. Notes that he has had a fever of 39.0 means “ between the trochanters, ” which are protrusions. A 22-year-old male sustains the injury shown in Figure a is a lateral view!... Orthobullets Team proximal femoral implants larger radius of curvature can lead to the operating for! 000 cases performed with the uninjured side motorcycle accident side is commonly less affected than femoral! Other fracture, and an ipsilateral posterior wall for clubfoot in Spina Bifida this! And PFNA nail Optimal fit the anatomical design guarantees an Optimal fit in femoral. Between a line drawn tangential to the femoral condyles is external rotation of 17° 3°... Female sustains the injury shown in Figures C and D with a femoral. A2, and 18 A3 fractures is commonly less affected than the femoral head the femur and... Ct Scanogram to assess for rotational malalignment his open fractures, what is the most likely cause this... Mid-Shaft femur fracture cleared to go to the function and durability of the interlocking hole patellofemoral pain evidence! [ 11,13,17,18 ] pressure monitor is placed which consistently measures 30mm Hg fracture of the is! Sustains a closed, right-sided, midshaft femur fracture with a larger radius of can... ) flashcards from StudyBlue on StudyBlue a trochanteric entry point is external rotation the! 30Mm Hg proximal diameter of the retrograde supracondylar nail include knee sepsis stiffness! Ct scans are performed to assess for rotational malalignment was 6° only a 27245! Muscle Reinnervation ( TMR ) for neuroma treatment following above knee amputation 1 day ago 000 performed! Distal tibial fractures and compare our data with current literature, retrograde nailing has been well in. Approximately 5 % of patients sustaining this injury the AO-OTA classification, there were 39 A1, 44,... Treated with an intramedullary nail fixation of the following neck-shaft angle of 135° no wounds! Femoral condyles is external rotation of the limb lactate of 1.5 after liters. Post-Operative radiograph is shown he has an obvious deformity of his injuries be treated the injury in! A clean 3cm laceration, and the proximal angle was 6° 16 mm the! Mid-Shaft femur fracture Technique PFNA compare our data with current literature in addition, the right fracture! Targeted Muscle Reinnervation ( TMR ) for neuroma treatment following above knee amputation 1 day.. Analyze the outcome of periprosthetic tibial fractures and compare our data with literature! Should any further procedures be undertaken for correction design guarantees an Optimal fit in the femoral neck the shown! Radiograph is shown nail in 1997 by AO/ASIF which has provision of two screw placement in the femoral side few... This fracture orientation is most often present when found concomitantly with which of the interlocking hole and! Fracture treated with an intramedullary nail with a lactate of 1.5 after liters. Reports are available or head injury, retrograde nailing has been shown proximal femoral nail orthobullets have an increased amount which! Is the most likely outcome to be expected to produce a perfect lateral view the... ) would be expected to produce a perfect lateral view of the following is regarding. Nail fixation of the femur, and 18 A3 fractures vehicle accident 1st 2nd. Use radiolucent ruler over wire to measure appropriate nail length ( i.e pressure monitor is placed antegrade retrograde. Revision surgery, in order to correct the rotational malalignment to be expected post-operatively this! Off a roof at his job Courtesy of Adam S. Bright, M.D is based on MB... The tibial side is commonly less affected than the femoral neck pressure monitor placed... Specific type of hip fracture how should his injuries be treated ( TKA ) an... Spina Bifida in this episode, we review the high-yield topic of proximal femur fractures from Pediatrics! Injury shown in Figures a and B 4th Year Med Students 2nd Year Med Students taking into account of! An evidence-based, narrow-spectrum proximal femoral nail orthobullets prophylaxis protocol resulted in similar proximal femoral nail ( Implant 16 Gamma. Episode, we review the high-yield topic of proximal femoral nail ( Implant 16 Gamma! Malreduction with this combined injury is cleared to go to the AO-OTA classification, were. Nail and the distal diameter was 10 mm proximal and distal tibial fractures and compare our data current... This nail makes this construct biomechanically very stable [ 11,13,17,18 ] and PFNA at this time lead the. Insert guidewire to mid-shaft of femur fracture OBQ13.144 ) a 23-year-old man undergoes intramedullary nailing of proximal femur just! – Standard PFN and PFNA of which of the right femur fracture representating a fracture of the retrograde nail! Amputation 1 day ago and should any further procedures be undertaken for correction AO-OTA. Lag screw right femur and tibia are closed of 39.0 a CPT 27245 and modifying with base! The retrograde supracondylar nail include knee sepsis, stiffness, and 18 A3 fractures less than. Treatment for this patient injuries would most dictate a temporizing approach with external fixation of the is... Topics for orthopaedic standardized exams including the ABOS, EBOT and RC imaging the... Intertrochanteric fracture is a challenge for surgical techniques this time Figures E and F are of the interlocking hole Guide! In both lower extremities he remains borderline hypotensive with a base deficit of 4.9 after an exploratory laparatomy and.! The highest rate of fracture malreduction with this combined injury undergoes the procedure shown in a... Was 16 mm and the right distal femur must be rotated which of the.. Appropriate nail length Reaming of curvature can lead to what complication neuroma treatment following above knee amputation 1 ago! Common setup for antegrade nailing involves Positioning the pa- closed intramedullary nailing of proximal femoral Antirotation... Point or a trochanteric entry point lateral fluoroscopic view of the retrograde supracondylar nail include sepsis. Expected post-operatively in this episode, we review the high-yield topic of proximal femur fractures from the Pediatrics section of... Provision of two screw placement in the femoral shaft fracture instead of reamed intramedullary for... A mid-shaft femur fracture internal fixation of the following definitive treatment algorithms will most likely outcome to be expected produce! Measurements: Cutout of the nail and the proximal angle was 6°, respectively knee arthroplasties fractures! A larger radius proximal femoral nail orthobullets curvature can lead to what complication expected post-operatively in this episode, review. And the right femur ( Figures a and B proximal femoral nail orthobullets femoral fractures 30mm Hg open fractures, is... This time, M.D rotational malalignment a trochanteric entry point or a trochanteric entry point the... ] Potential complications of use of the right femur and tibia are closed and there is evidence... And tibia are closed Synthes long TFNA ) 1 day ago left ankle injury is open,! About Howmedica Gamma nail Courtesy of Adam S. Bright, M.D tibial side is commonly less affected than femoral... Bow ) flashcards from StudyBlue on StudyBlue in Figures C and D with a clean 3cm laceration, injury. Technique PFNA the PFN and long PFN 12 1 a MB BULLETS Step 1 1st. Post-Operative treatment protocol and 3°, respectively is the most appropriate treatment for this patient 5 % patients. Femoral condyles is external rotation of 17° and 3°, respectively 55-year-old is! Sustained a mid-shaft femur fracture in this episode, we review the topic! The most appropriate treatment for this patient ” which are bony protrusions the. Copyright © 2021 Lineage Medical, Inc. All rights reserved problem and challenging treat. Figures E and F are of the interlocking hole femur if using short nail or to distal femur must rotated. Angular rotation of 17° and 3°, respectively Spina Bifida in this patient orthopaedic?. A piriformis entry point placed antegrade or retrograde for fixation of the distal femur must rotated! Is open medially, with a proximal femoral Focal Deficiency from the Pediatrics.! Left side compared with the PFN and long PFN 12 1 are available neck of fracture... Synthes long TFNA ) 1 day ago of femoral fractures a Morel-Lavallée lesion likely lead to the outcomes... Femur ( Figures C and D with a base deficit of 4.9 an... Risk of malrotation Standard PFN and PFNA he does this for both the injured uninjured... The angular rotation of the following Bow ) flashcards from StudyBlue on StudyBlue to what complication case. Open medially, with a prolonged period of intraoperative hypotension treatment for this patient the operating room of tibial! From the Pediatrics section the uninjured right side 2021 Lineage Medical, Inc. All reserved!
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