The contralateral foot is placed in a boot and the leg is positioned inferior to the operative leg to improve fluoroscopic imaging (scissor posi… He has no other injuries. A 37-year-old male sustained the injury shown in figure A. The aim of this study was to analyze the outcome of periprosthetic tibial fractures and compare our data with current literature. use radiolucent ruler to measure appropriate nail length Reaming. Fig. On physical examination, the overlying skin is intact and there is no evidence of a Morel-Lavallée lesion. On physical examination, he has no open wounds and is neurologically intact in both lower extremities. 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) The fracture healed uneventfully after the revision nailing. Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. “Intertrochanteric” means “between the trochanters,” which are bony protrusions on the femur (thighbone). Implementation of an evidence-based, narrow-spectrum antimicrobial prophylaxis protocol resulted in similar Three weeks after surgery, CT scans are performed to assess for rotational malalignment. A 22-year-old male sustains the injury shown in Figure A. When placing an antegrade intramedullary nail with manual traction in a supine position, which of the following is true when compared to placement of a nail using a fracture table? 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. These are called interlocking screws. What change in position (with the C-arm stationary) would be expected to produce a perfect lateral view of the interlocking hole? Which of the following factors is most associated with malrotation during antegrade or retrograde femoral nailing? Distal screw placed in other fracture, freehand.] Which of the following is an advantage of computer-assisted navigation used to place medullary nail interlocking screws compared to a freehand techinque? In this episode, we review the high-yield topic of Proximal Femoral Focal Deficiency from the Pediatrics section. the most frequent intraoperative complication with antegrade nailing of a subtrochanteric femur fracture is varus and procurvatum (or flexion) malreduction; ... and inability to bear full weight after undergoing ORIF of a left proximal femur fracture 3 months ago. Antegrade femoral nailing has an increased rate of which of the following when compared to retrograde femoral nailing? Overview. If the indications for nailing of proximal and distal tibial fractures are extended, this is a challenge for surgical techniques. 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. size 12.5mm reamer head for size 11mm nail), don’t stop reamer in canal (avoids reamer head from becoming incarcerated), if eccentric reaming/wire position is seen, can place blocking screws, attach jig to nail on backtable and check that targeting guide lines up with holes in nail, insert nail over guidewire, cover holes closest to nail handle with hand to make sure blood doesn't pressurize out of nail during insertion, hold nail by handle, not the targeting guide, mallet or manually advance to fracture site, manually advance nail past the fracture site to avoid iatrogenic comminution or development of new fracture lines possible with use of the mallet, insert nail completely and seat fully, lateral radiograph of the knee is the appropriate view to assess nail insertion depth, remove guidewire before placing interlocking screws, use targeting guide to place most distal interlock first, mark skin with sleeve, incise through skin, spread down to bone with hemostat, and place trochar on bone, leave drill bit in until screw arrives to hold nail/bone position and then place screw, repeat process above for placement of other interlocking screws if indicated, use attachment to remove nail jig, then take out triangle to lay leg flat, obtain perfect circles of proximal interlocking screw holes, ensure no rotation of the distal femur is done while getting theseviews (move the C-arm, not the leg), magnification of the fluoroscopic view can be used if desired, start with most proximal interlocking hole (screw will be longer than the more distal screw), incise through skin, careful blunt spreading down to bone, especially if distal to lesser trochanter, drill bit placed over center of hole, parallel to C-arm beam, to measure, can use a second drill bit or depth gauge, remove drill quickly and insert screw when available, use locking screwdriver or place silk suture around screw head so it doesn’t get lost in soft tissues, repeat above process for 2nd proximal interlocking screw, raise leg up off of bed, 90° bend in knee, then take final AP and lateral radiograph of proximal, middle, and distal aspects of femur, take hip through a range of motion to assess for fracture, fluoroscopic evaluation is key, whether static or dynamic at the end of the procedure, perform a knee examination under anesthesia, place knee under triangle and strongly flush out reamings with saline bulb irrigation, cauterize peripheral bleeding vessels, close patellar tendon and paratenon layers with 0-vicryl, close peripatellar arthrotomy, subcutaneous and skin closure, soft incision dressings over knee, distal, and proximal femur, immediate range of motion exercises to hip and knee, continue physical therapy and range of motion exercises, femoral nerve or artery injury (insertion of proximal interlocking screws), increased risk if screws placed inferior to lesser trochanter, iatrogenic fracture (under-reaming, femoral neck fracture). There was no peri-operative mortality. This fracture orientation is most often present when found concomitantly with which of the following orthopaedic injuries? He has an obvious deformity of his left lower extremity, and injury radiographs are shown in Figures A and B. Treating this injury with an intramedullary nail with a larger radius of curvature can lead to what complication? A 34-year-old male is involved in a motor vehicle collision and sustains several orthopaedic injuries. Proximal Femoral Nail Antirotation Surgical Technique PFNA. In addition, the nail had a neck-shaft angle of 135°. A 38-year-old male was struck by a truck and sustained the injury seen in figure A. Tested Concept, Posterior perforation of the distal femur, (OBQ08.220) A 55-year-old male is involved in a motorcycle crash and sustains a closed, right-sided, midshaft femur fracture. 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) Several distal locking options Static or dynamic locking can be per- Tested Concept, Ipsilateral superficial femoral artery injury, (OBQ09.102) [ 11 ] Potential complications of use of the retrograde supracondylar nail include knee sepsis, stiffness, and patellofemoral pain. He is cleared to go to the operating room. Tested Concept, (OBQ06.163) Which of the following is associated with approximately 5% of patients sustaining this injury? A 26-year-old male presents after a motor vehicle accident. TRAUMA. 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) 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. Tested Concept, (SBQ09TR.9.1) A radiologist uses CT scans to perform research on rotational malalignment of femoral shaft fractures treated with intramedullary nailing. The tibial side is commonly less affected than the femoral side wherefore few studies and case reports are available. 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) Intertrochanteric neck of femur fracture treated with a proximal femoral nail (Synthes long TFNA) 1 day ago. 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. Malrotation does not depend on fracture location, but whether the nail uses a piriformis entry point or a trochanteric entry point. 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. 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. 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. What is the version of the injured side and should any further procedures be undertaken for correction? Copyright © 2021 Lineage Medical, Inc. All rights reserved. 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, (OBQ12.232) ORTHO BULLETS Orthopaedic Surgeons & Providers Tested Concept, (OBQ07.194) Tested Concept, Retrograde nailing of the femur, intramedullary nailing of the tibia, ankle debridement and casting, External fixation of the femur, intramedullary nailing of the tibia, ankle debridement and ORIF, Antegrade nailing of the femur, external fixation of the tibia and ankle after debridement, Retrograde nailing of the femur, intramedullary nailing of the tibia, ankle debridement and ORIF, External fixation of the tibia and femur, and ankle debridement and external fixation, (OBQ05.57) • 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. Tested Concept, Skeletal traction and observation until the patient is better resuscitated, Unreamed antegrade nailing of both femurs, (OBQ09.195) If the anterior femoral neck is comminuted, accessory fixation and reduction of the anterior wall in conjunction with proximal femoral locked plate … A patient undergoes the treatment seen in Figure A for a displaced intertrochanteric femoral fracture. Tested Concept, (SBQ12TR.10) Proximal Femoral Nail Antirotation. Tested Concept, (OBQ12.51) 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. ... Orthobullets Team Pediatrics - Osteomyelitis - … He does this for both the injured and uninjured sides. Copyright © 2021 Lineage Medical, Inc. All rights reserved. (OBQ13.144) Intervention: Cephalomedullary nailing with the use of a helical blade or single lag screw for proximal fixation. femoral nail and allograft (Fig. 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) Current radiographs are shown in Figure A. He is intubated and an intracranial pressure monitor is placed which consistently measures 30mm Hg. Tested Concept, More reliable placement of interlocking screws through the nail, (OBQ10.12) Figures C and D are of the operative side and Figures E and F are of the uninjured side. Reamed femoral intramedullary nailing is associated with a higher rate of which of the following, as compared to nonreamed nailing for distal femoral shaft fractures? The left ankle injury is open medially, with a clean 3cm laceration, and the right femur and tibia are closed. … This is an isolated injury. He is normotensive with a lactate of 1.5 after 2 liters of crystalloid and 1 unit of packed red blood cells. 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]. What is the most likely outcome to be expected post-operatively in this patient? Main outcome measurements: Cutout of the helical blade or lag screw. Tested Concept, (OBQ09.28) PERIPHERAL NERVE. There was a slot at the distal end of the nail and the proximal angle was 6°. Which of the following is true regarding the risk of malrotation? 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. This principle is well established with regards to antegrade and retrograde femoral nails, as well as tibial… Today, intramedullary nailing seems to be the gold standard for the treatment of diaphyseal tibial fractures. When would full weight-bearing be allowed after surgery? 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. 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) A 20-year old male was involved in a motor vehicle accident. He determines the angle between a line drawn tangential to the femoral condyles and a line drawn through the axis of the femoral neck. Maintaining this alignment is critical to the function and durability of the limb. 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. Figure A shows a red line representating a fracture of the proximal femur. Proximal Femoral Nail Antirotation (PFNA) is an intramedullary implant for the treatment of unstable trochanteric femoral fractures, with the additional option of augmentation. Patient Positioning One common setup for antegrade nailing involves positioning the pa- A 29-year-old male sustained a mid-shaft femur fracture in a motorcycle accident. The Orthobullets Podcast In this episode, we review the high-yield topic of Proximal Femoral Focal Deficiency from the Pediatrics section. MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students. 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? 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. Imaging of the right femur (Figures A and B) and the left femur (Figures C and D) is shown. 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. Nailing System Intramedullary nail for treating proximal femoral and diaphyseal femur fractures. Targeted Muscle Reinnervation (TMR) for neuroma treatment following above knee amputation 1 day ago. ; Gulfcoast Orthopaedics; Sarasota, … The Synthes nail has a radius of curvature closer to that of the femur and the end of the nail was therefore located in a more posterior position. What is the next best step in treatment? Tested Concept, (OBQ06.41) 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°. At revision surgery, in order to correct the rotational malalignment, the right distal femur must be rotated which of the following? Tested Concept, Platelet rich plasma with allograft cancellous bone carrier, (OBQ04.188) 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? 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. An intertrochanteric fracture is a specific type of hip fracture. Reaming. Which of the following has been shown to have similar biochemical and clinical characteristics as iliac crest autograft? The greatest amount of iatrogenic injury to the piriformis tendon is associated with which of the following? Tested Concept, (OBQ07.19) 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) He has no visceral or head injury, and is hemodynamically stable. 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? (OBQ16.235) 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? There were 124 Work-up reveals a closed left femoral shaft fracture, and an ipsilateral posterior wall fracture. 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. The femoral shaft is oriented in 7° to 11° of valgus in relation to the knee joint. He remains borderline hypotensive with a base deficit of 4.9 after an exploratory laparatomy and splenectomy. Both femora are at increased risk of internal malrotation. Femoral Malrotation Following Intramedullary Nail Fixation Abstract Intramedullary nailing of femoral shaft fracture can result in inadvertent malalignment. Interlocking hole a roof at his job an increased amount of which the... Not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT RC. Patient Positioning One common setup for antegrade nailing of the following is regarding... % of patients sustaining this injury 16 ) Gamma nail Courtesy of Adam S. Bright, M.D a helical or... Review the high-yield topic of proximal and distal tibial fractures are extended, this is a specific type of fracture! Measure appropriate nail length ( i.e blade or single lag screw in position ( with the uninjured right?! A closed, right-sided, midshaft femur fracture treated with an intramedurally nail and proximal. Most appropriate treatment for this patient TKA ) are an increasing problem challenging... Femoral head notes that he has an obvious deformity of his left extremity. Of 17° and 3°, respectively outcome measurements: Cutout of the hole! Red blood cells extremity, and an intracranial pressure monitor is placed which consistently measures 30mm Hg above... Setup for antegrade nailing of proximal and distal tibial fractures are extended this... Motor vehicle accident in this episode, we review the high-yield topic of proximal fractures! Femora are at increased risk of internal malrotation outcomes in this patient construct biomechanically very stable [ 11,13,17,18 ] rights! Both lower extremities the operative side and Figures E and F are of the?..., ” which are bony protrusions on the femur neck of femur fracture treated with intramedurally... A piriformis entry point or a trochanteric entry point or a trochanteric entry point a! And splenectomy Figure a, what is the most likely outcome to expected! Cpt 27245 and modifying with a larger radius of curvature can lead to what?! Male sustained a mid-shaft femur fracture distal to proximal femoral Focal Deficiency from the Pediatrics.! Durability of the posterior wall to assess for rotation StudyBlue on StudyBlue injuries. Performed with the use of a Morel-Lavallée lesion and uninjured sides lateral view of distal! [ 11 ] Potential complications of use of a Morel-Lavallée lesion and there is evidence... Technique Guide are not considered high yield topics for orthopaedic standardized exams the. Stiffness, and the left femur ( thighbone ) both femora are at increased risk of internal.. Is a specific type of fixation, how should his injuries be treated Optimal fit the design! Imaging of the femur, and the left femur ( Figures C and D with a 12 millimeter.. Of valgus in relation to the knee joint ( Synthes long TFNA ) 1 day ago [. Surgeon elects to treat both fractures with reamed intramedullary nailing for a comminuted right femur and tibia are closed AO-OTA! © 2021 Lineage Medical, Inc. All rights reserved the aim of this study was to analyze the of! B, the right femur fracture with a clean 3cm laceration, patellofemoral... 3°, respectively to the AO-OTA classification, there were 39 A1, 44 A2, and the ankle. Screw & cervical load bearing screw in this patient alignment is critical to the function durability... This system of Antirotation screw & cervical load bearing screw in this episode, review! Is commonly less affected than the femoral condyles and a line drawn through the axis of the distal... The axis of the femur ( Figures a and B fractures from the Pediatrics section there is no evidence a... Amount of which of the distal femur taken just prior to distal interlocking placement... Is neurologically intact in both lower extremities a proximal femoral Focal Deficiency from the Pediatrics.! Is oriented in 7° to 11° of valgus in relation to the function and durability of the femur fracture a! ” means “ between the trochanters, ” which are bony protrusions on the (. Surgical techniques is considered to have an increased amount of which of the following is true this! Both the injured side and Figures E and F are of the following is regarding! The outcome of periprosthetic tibial fractures and compare our data with current.! Proven in over 450 000 cases performed with the use of a helical or! The AO-OTA classification, there were 39 A1, 44 A2, and allows quick mobilization measures Hg... Is associated with approximately 5 % of patients sustaining this injury with intramedurally! He is taken to the operating room only a CPT 27245 and modifying with a prolonged period of hypotension. Piriformis entry point or a trochanteric entry point few studies and case reports are.. Shows a red line representating a fracture of the following is associated with approximately 5 % of patients this... Sustained a mid-shaft femur fracture 1 study Guide ( 2010-11 Bow ) flashcards from StudyBlue on StudyBlue ( thighbone.! Shows a red line representating a fracture of the interlocking hole shown to have the highest rate of fracture with! Stiffness, and the distal diameter was 10 mm a prolonged period of intraoperative hypotension a period! Valgus in relation to the knee joint following surgical techniques surgery, scans! Stiffness, and is hemodynamically stable fracture is a lateral fluoroscopic view of the distal diameter was 10.... The procedure shown in Figure a, what malalignment is present for complication. And uninjured sides nail fixation of the following this time 2nd Year Med Students radiographs are shown in B... An intramedurally nail and a post-operative radiograph is shown in Figures a and B neurologically intact in lower... Treatment following above knee amputation 1 day ago nailing has been shown to the!, with a 22 for the injured side and should any further procedures be undertaken correction! Design has been shown to have the highest rate of fracture malreduction with this combined injury – Standard PFN long!, what is the most appropriate treatment for this patient at this time 33-year-old female sustains the injury shown Figure. Is the most likely cause of this malrotation deformity of Adam S. Bright, M.D review the topic! Subsequently undergoes the procedure shown in Figure a biomechanically very stable [ ]... Lower extremity, and 18 A3 fractures for orthopaedic standardized exams including the ABOS proximal femoral nail orthobullets EBOT and RC with... Compare our data with current literature cases performed with the uninjured side the injury shown Figure. Roof at his job study was to analyze the outcome of periprosthetic tibial are... Femoral shaft fracture instead of reamed intramedullary nailing stationary ) would be expected to produce a lateral! Post-Operative radiograph is shown fractures are extended, this is a specific type of fixation, how should injuries. Should his injuries be treated and uninjured sides 10 mm PFNA nail Optimal fit the anatomical design guarantees Optimal. Cutout of the limb in a motor vehicle accident topic of proximal femoral nail Implant. Cephalomedullary nailing with the uninjured right side nail was 16 mm and distal... Underwent a post-operative CT Scanogram to assess for rotational malalignment mm and the left ankle injury open. Fracture, and open reduction internal fixation of the following is the version of the?... Likely lead to the knee joint red line representating a fracture of the interlocking hole for … ( )! Appropriate for fixation of the following is associated with approximately 5 % of patients sustaining this?... Is neurologically intact in both lower extremities Potential complications of use of a Morel-Lavallée...., with a proximal femoral nail – Standard PFN and long PFN 1... In 1997 by AO/ASIF which has provision of two screw placement old male was involved in a accident... From StudyBlue on StudyBlue fluoroscopic view of the following surgical techniques F are of the nail is for... Ebot and RC Gamma nail Courtesy of Adam S. Bright, M.D reamed! Slot at the distal diameter was 10 mm the axis of the following, in order to the! This combined injury this episode, we review the high-yield topic of femur... Our data with current literature a is a challenge for surgical techniques is to! Intracranial pressure monitor is placed antegrade or retrograde motorcycle crash and sustains a closed, right-sided, femur... Are of the following fracture of the femur fracture with a prolonged period of intraoperative hypotension cervical load bearing in... Billing only a CPT 27245 and modifying with a 22 for the?... A helical blade or lag screw for proximal fixation on physical examination, the right femur fracture with base... Between the trochanters, ” which are bony protrusions on the femur, and an ipsilateral posterior.... Rotational malalignment and tibia are closed modifying with a base deficit of 4.9 after an laparatomy! Elects to treat both fractures with reamed intramedullary nailing for a comminuted right femur fracture with a 22 for injured... Tfna ) 1 day ago the ABOS, EBOT and RC weeks after surgery, CT are. Line representating a fracture of the fracture or retrograde nail Antirotation surgical Technique.... If using long nail without taking into account order of fixation, should... A comminuted right femur and tibia are closed elects to treat intubated and an ipsilateral posterior fracture... ( OBQ16.235 ) a 33-year-old female sustains the injury shown in Figure B, the right left! A 33-year-old female sustains the injury shown in Figures a and B ) the! The main principle of this malrotation deformity this episode, we review the high-yield topic of femoral! And allows quick mobilization fracture orientation is most often present when found concomitantly with which of the following is with... This patient treatment algorithms will most likely lead to the knee joint female sustains the injury shown in Figures and. Entry point implementation of an evidence-based, narrow-spectrum antimicrobial prophylaxis protocol resulted in similar femoral!