Flashcards in Femoral Shaft Fractures Deck (25):
In femoral shaft fractures what is the incidence of femoral neck fractures and how often are they missed?
They are often basicervical, vertical and nondisplaced
What presenting factors are increased in bilateral compared to unilateral femoral shaft fractures?
Increased rates of initial hypotension, mortality, open skull fractures, and pelvic fractures
Which classification system describes femoral shaft fractures?
Winquist and Hansen:
0- Non displaced
I- minimal comminution
II- >50% cortical contact
III- >25% cortical contact
IV- No cortical contact; segmental
In a high energy femoral shaft fracture what radiographs should be obtained?
1) AP/Lat femur
2) AP/Lat ipsilateral hip
3) AP/Lat ipsilateral knee
4) Trauma series: AP chest, AP pelvis, Lateral c-spine
IM nailing of femur shaft fractures within 24hrs of injury are a/w?
1) decreased pulmonary complications (ARDS)
2) decreased thromboembolic events
3) improved rehabilitation
4) decreased length of stay and cost of hospitalization
Except in closed head injuries; consider DCO
In a patient with a major head injury and a femoral shaft fracture, intraoperative hypotension during femoral fixation has been associated with?
Decreased (worse) Glascow coma score at discharge
What are indications for retrograde nailing of femoral shaft fractures?
1) ipsilateral femoral neck fracture
2) floating knee (ipsilateral tibial shaft fracture); use same incision for tibial nail
3) ipsilateral acetabular fracture; does not compromise surgical approach to acetabulum
4) multiple system trauma
5) bilateral femur fractures; avoids repositioning
6) morbid obesity
When would plating be an indication for a femoral shaft fracture?
1) ipsilateral neck fracture requiring screw fixation
2) fracture at distal metaphyseal-diaphyseal junction
3) inability to access medullary canal
What are the outcomes of ORIF of femoral shaft fractures with plates vs IM nailing?
Inferior d/t increased rates of:
3) hardware failure
Antegrade femoral nailing has an increased rate of which of the following when compared to retrograde femoral nailing?
retrograde has increased incidence of knee pain
What are the pros and cons of a piriformis entry nail for femoral neck fractures?
Colineal with femoral shaft
More abductor trauma
Can lead to AVN in peds
More difficult in obese pts
When using a trochanteric entry nail, placement of the starting point more lateral will lead to what deformity?
How does reamed compared to unreamed nailing of femoral shaft fractures?
1) increased union rates
2) decreased time to union
3) no increase in pulmonary complications
When would unreamed nailing of femur fractures be considered?
Pt with bilateral pulmonary injuries
What is an advantage of computer-assisted navigation used to place medullary nail interlocking screws compared to a freehand technique?
Decreased fluoro time
When can pts with a comminuted femoral shaft fractures treated with statically locked intramedullary nails of appropriate diameter be WBAT?
In a patient with a femoral shaft fracture with ipsilateral femoral neck, what is the order that the fractures are stabilized?
1) Femoral neck
2) Femoral shaft
screws for neck with retrograde nail for shaft
screws for neck and plate for shaft
compression hip screw for neck with retrograde nail for shaft
During external fixation of the femur what are the safest locations for pin placement?
Anterolateral and direct lateral
During retrograde IM nailing of femoral shaft fracture which screw position places branches of the femoral nerve and deep femoral artery at greatest risk during placement of the interlocking screw?
Proximal AP screw below the lesser trochanter
What are risk factors for rotational deformity when placing IM nail for femoral shaft fxs?
1) Fx table vs free leg
3) Night-time surgery
What are intraoperative tricks to avoid rotational deformities during IM nailing of femoral shaft fractures?
What relationship does lengthening/shortening along the anatomical axis of the femur have to mechanical axis deviation (MAD)?
Lengthening: Lateral deviation of MAD
Shortening: Medial deviation of the MAD
In femoral shaft fractures how is fracture location related to risk of rotational deformity?
Proximal tends towards internal malrotation (relative as proximal fragment is externally rotated)
Distal fractures tend towards external malrotation (proximal fragment pulled medially and internal rotation)
In retrograde nailing of periprosthetic distal femur fractures what deformity is common?
Starting point tends to be more posterior