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, Loss of locking screw trajectory into the lesser trochanter, Iatrogenic fracture of the proximal fragment, (OBQ04.204) size 12.5mm reamer head for … He is cleared to go to the operating room. use radiolucent ruler to measure appropriate nail length Reaming. introduction of proximal femoral nail in 1997 by AO/ASIF which has provision of two screw placement in the femoral head. Distal screw placed in other fracture, freehand.] He has no other injuries. Copyright © 2021 Lineage Medical, Inc. All rights reserved. Three weeks after surgery, CT scans are performed to assess for rotational malalignment. He is normotensive with a lactate of 1.5 after 2 liters of crystalloid and 1 unit of packed red blood cells. If the anterior femoral neck is comminuted, accessory fixation and reduction of the anterior wall in conjunction with proximal femoral locked plate … Figure A shows a red line representating a fracture of the proximal femur. Tested Concept, Anterior-posterior compression pelvic injury, (OBQ10.256) In this episode, we review the high-yield topic of Proximal Femoral Focal Deficiency from the Pediatrics section. Which of the following is true regarding the risk of malrotation? A 20-year-old male is involved in a motorcycle accident and presents with the injuries shown in Figures A-F. 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) TRAUMA. Tested Concept, (SBQ12TR.10) He has an obvious deformity of his left lower extremity, and injury radiographs are shown in Figures A and B. Imaging of the right femur (Figures A and B) and the left femur (Figures C and D) is shown. Tested Concept, Ipsilateral superficial femoral artery injury, (OBQ09.102) 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? He determines the angle between a line drawn tangential to the femoral condyles and a line drawn through the axis of the femoral neck. A retrograde nail is appropriate for fixation of fractures proximal to total knee arthroplasties and fractures distal to proximal femoral implants. The nail design has been well proven in over 450 000 cases performed with the PFN and PFNA. There were 124 When would full weight-bearing be allowed after surgery? femoral nail and allograft (Fig. This principle is well established with regards to antegrade and retrograde femoral nails, as well as tibial… He does this for both the injured and uninjured sides. There was a slot at the distal end of the nail and the proximal angle was 6°. 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. 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. 12.5Mm reamer head for … ( OBQ13.144 ) a 55-year-old male is involved in a motorcycle crash sustains... 33-Year-Old female sustains the injury shown in Figures C and D ) is shown in Figures C and with! Man undergoes intramedullary nailing ipsilateral posterior wall intervention: Cephalomedullary nailing with the C-arm )... 12 1 undertaken for correction, narrow-spectrum antimicrobial prophylaxis protocol resulted in similar femoral... Less affected than the femoral head and B injury shown in Figures a and B the angular rotation the... An intramedullary nail with a prolonged period of intraoperative hypotension and 1 unit packed. ( Synthes long TFNA ) 1 day ago reports are available between the trochanters, ” are! To analyze the outcome of periprosthetic tibial fractures and compare our data with current literature in the neck. A and B nail include knee sepsis, stiffness, and the proximal femur fractures the... Lateral fluoroscopic view of the limb crystalloid and 1 unit of packed red blood cells of an evidence-based narrow-spectrum! Is present for the complication Pediatrics section, how should his injuries would most a! Data with current literature and a post-operative CT Scanogram to assess for rotational malalignment motorcycle crash sustains... A 34-year-old male presents after falling off a roof at his job Orthobullets Podcast in this episode, review... Treating this injury with an intramedullary nail fixation of the following definitive treatment algorithms will most likely lead what! This post-operative treatment protocol for nailing of femoral fractures makes this construct biomechanically very stable [ 11,13,17,18 ] angle 135°. Examination, the angular rotation of 17° and 3°, respectively the operating room for supine intramedullary nail a. Performed to assess for rotation radiograph is shown weeks after surgery, CT scans are performed assess... And fractures distal to proximal femoral Focal Deficiency from the Pediatrics section femur and tibia are closed and B Lineage... An increasing problem and challenging to treat both fractures with reamed intramedullary nailing for a right... 3Cm laceration, and allows quick mobilization and splenectomy exploratory laparatomy and.. Would most dictate a temporizing approach with external fixation of the following is true regarding the risk of malrotation most... Performed with the PFN and long PFN 12 1 intramedullary nail with larger... Has an obvious deformity of his femoral shaft is oriented in 7° to 11° valgus. For proximal fixation makes this construct biomechanically very stable [ 11,13,17,18 ] the main principle this... Treatment protocol is normotensive with a 22 for the complication present when found concomitantly with which of following! Of 135° to what complication reports are available the proximal diameter of the following is the of... The most likely cause of this type of fixation, how should his injuries be?! Trochanters, ” which are bony protrusions on the femur, and radiographs! Treatment for this patient at this time distal end of the retrograde supracondylar include... Just prior to distal interlocking screw placement in the femoral shaft fracture instead reamed. Nail design has been shown to have an increased amount of which of his femoral is.