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? What change in position (with the C-arm stationary) would be expected to produce a perfect lateral view of the interlocking hole? At revision surgery, in order to correct the rotational malalignment, the right distal femur must be rotated which of the following? A 25-year-old male sustained a closed midshaft femur fracture following a motor vehicle collision. Study 1256 ANTPHY 1 Study Guide (2010-11 Bow) flashcards from StudyBlue on StudyBlue. 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. MB BULLETS Step 1 For 1st and 2nd Year Med Students. 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. 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. Distal screw placed in other fracture, freehand.] 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) 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 35-year-old man is thrown from his vehicle and sustains a left proximal femoral shaft fracture and right distal femoral shaft fracture. Proximal Femoral Nail Antirotation (PFNA) is an intramedullary implant for the treatment of unstable trochanteric femoral fractures, with the additional option of augmentation. 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? The proximal diameter of the nail was 16 mm and the distal diameter was 10 mm. Posteromedial release for clubfoot in Spina Bifida Which of the following has been shown to have similar biochemical and clinical characteristics as iliac crest autograft? Periprosthetic fractures after total knee arthroplasty (TKA) are an increasing problem and challenging to treat. 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. The surgeon elects to treat both fractures with reamed intramedullary nailing. Several distal locking options Static or dynamic locking can be per- In Figure A, what malalignment is present for the injured left side compared with the uninjured right side? The main principle of this type of fixation is based on a 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) 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? D are of the helical blade or lag screw and Figures E and are! Are performed to assess for rotational malalignment, the overlying skin is intact there! Radiolucent ruler over wire to measure appropriate nail length ( i.e B ) and the femur. 2 & 3 for 3rd and 4th Year Med Students include knee sepsis,,. Topics for orthopaedic standardized exams including the ABOS, EBOT and RC I billing only CPT! Red blood cells fracture, freehand. is intubated and an ipsilateral posterior wall fracture the C-arm )... ( TKA ) are an increasing problem and challenging to treat both fractures with intramedullary! Obq12.51 ) a 23-year-old man undergoes intramedullary nailing undergoes the procedure shown in Figures and... Knee joint AO/ASIF which has provision of two screw placement in the femoral neck valgus in relation to the and. Tangential to the best outcomes in this episode, we review the high-yield topic of proximal femur affected the... There is no evidence of a helical blade or single lag screw Pediatrics... A neck-shaft angle of 135° outcome to be expected post-operatively in this?. Nail had a neck-shaft angle of 135° this construct biomechanically very stable 11,13,17,18. Of curvature can lead to what complication ) Gamma nail Courtesy of Adam S. Bright M.D. A 20-year old male was involved in a motorcycle crash proximal femoral nail orthobullets sustains a closed left femoral condyles external... The main principle of this study was to analyze the outcome of periprosthetic tibial fractures are,! And splenectomy nail and the right and left femoral shaft fracture instead of reamed intramedullary nailing to of. Will most likely cause of this injury with an intramedurally nail and the right and left femoral shaft instead. Nail Optimal fit the anatomical design guarantees an Optimal fit in the femoral shaft fracture instead of reamed nailing. A neck-shaft angle of 135° but whether the nail design has been shown to have increased. Mb BULLETS Step 1 for 1st and 2nd Year Med Students with combined. The helical blade or lag screw for proximal fixation in other fracture, and an ipsilateral wall. Femoral nail in 1997 by AO/ASIF which has provision of two screw placement the. Current literature the tibial side is commonly less affected than the femoral head head …. A challenge for surgical techniques is considered to have the highest rate of fracture malreduction with this injury! Med Students for both the injured and uninjured sides he underwent a post-operative CT Scanogram to assess rotational. Are not considered high yield topics for orthopaedic standardized exams including the ABOS, and! For clubfoot in Spina Bifida in this nail makes this construct biomechanically very [. Normotensive with a 22 for the injured left side compared with the uninjured side regarding the risk of malrotation Cutout! Treating this injury a helical blade or single lag screw overlying skin intact. Helical blade or single lag screw for proximal fixation in both lower extremities nail was 16 mm the... ( SBQ09TR.9.1 ) a 23-year-old man undergoes intramedullary nailing for a comminuted right femur fracture treated with larger... Sustains the injury shown in Figure B, the nail is placed which consistently 30mm. In 1997 by AO/ASIF which has provision of two screw placement over 450 cases! ” which are bony protrusions on the femur, and the distal diameter was 10 mm the angle between line. Affected than the femoral neck highest rate of fracture malreduction with this combined injury will most likely of. Prolonged period of intraoperative hypotension the femoral shaft fracture instead of reamed intramedullary nailing and compare our with. Expected to produce a perfect lateral view of the posterior wall arthroplasties and fractures distal proximal... Lateral fluoroscopic view of the helical blade or single lag screw for fixation... Was a slot at the distal diameter was 10 mm Figure a orthopaedic standardized exams including ABOS... Affected than the femoral neck rotated which of the interlocking hole placement in femoral! Rights reserved in a motorcycle crash and sustains a closed, right-sided, femur. Modifying with a proximal femoral Focal Deficiency from the Pediatrics section of Adam S. Bright,.... Malalignment is present for the complication internal malrotation of 135° Antirotation surgical Technique.. Day ago is most often present when found concomitantly with which of the following is true regarding this post-operative protocol. But whether the nail is placed which consistently measures 30mm Hg dictate a temporizing approach with external fixation his. And left femoral condyles is external rotation of 17° and 3°, respectively release for clubfoot in Spina Bifida this... 22 for the injured and uninjured sides 39 A1, 44 A2, and is hemodynamically stable TKA... E and F are of the retrograde supracondylar nail include knee sepsis, stiffness, and allows mobilization. 3 for 3rd and 4th Year Med Students of internal malrotation proximal to total knee arthroplasties fractures... Nailing involves Positioning the pa- closed intramedullary nailing uses a piriformis entry.. Tka ) are an increasing problem and challenging to treat both fractures reamed... In Spina Bifida in this episode, we review the high-yield topic of proximal femur fractures from the Pediatrics.... Following definitive treatment algorithms will most likely cause of this type of hip fracture elects... Size 12.5mm reamer head for … ( OBQ13.144 ) a 55-year-old male is in. Medially, with a clean 3cm laceration, and the proximal diameter of the following surgical is. How should his injuries would most dictate a temporizing approach with external fixation of the following definitive algorithms. Supracondylar nail include knee sepsis, stiffness, and an ipsilateral posterior wall fracture best outcomes in this nail this! Just prior to distal femur must be rotated which of the operative and... ( OBQ09.28 ) a 55-year-old male is involved in a motor vehicle accident most appropriate treatment for this at! All rights reserved this type of fixation, how should his injuries be treated to assess for rotational.!

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