David B. Weiss, MD Division Head Orthopaedic Trauma University of - - PowerPoint PPT Presentation

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David B. Weiss, MD Division Head Orthopaedic Trauma University of - - PowerPoint PPT Presentation

Apr 20, 2023 221 likes •433 views

David B. Weiss, MD Division Head Orthopaedic Trauma University of Virginia Disclosures In your program University of Virginia Orthopaedic Surgery Motocross Big Air Land Hard University of Virginia

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David B. Weiss, MD Division Head Orthopaedic Trauma University of Virginia

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University of Virginia Orthopaedic Surgery

Disclosures

  • In your program
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University of Virginia Orthopaedic Surgery

Motocross Big Air… Land Hard

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University of Virginia Orthopaedic Surgery

You are on call

  • And it’s Christmas Eve
  • What should you do?
  • Fix?

– When?

  • Replace?
  • Transfer?
  • Phone a Friend?
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University of Virginia Orthopaedic Surgery

Injury Films

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University of Virginia Orthopaedic Surgery

Selected CT cuts

Typical Deformity- Anterior tension failure with posterior comminution

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University of Virginia Orthopaedic Surgery

Selected CT cut

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University of Virginia Orthopaedic Surgery

Classification

  • Pauwel’s

– Based on verticality of fracture line through neck – Shearing forces increase as type does

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University of Virginia Orthopaedic Surgery

So Now What?

  • Isolated injury
  • Now 8 pm?
  • Send out an SOH…..
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University of Virginia Orthopaedic Surgery

ORIF SOH ….Save Our Hip

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University of Virginia Orthopaedic Surgery

Tactic

  • Anterior Smith Petersen approach

– Better visualization of neck vs. Watson Jones

  • Small mini fragment plate for temporary

reduction (leave in place)

  • Horizontal lag screw 1st
  • Fully threaded screw last to strut against varus
  • Screws placed through accessory lateral

incision

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University of Virginia Orthopaedic Surgery

Other Fixation Options

  • Sliding Hip screw
  • Proximal femoral locking

plate

  • Blade plate (technically

challenging)

  • How much head left for

fixation? (Know your implant)

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University of Virginia Orthopaedic Surgery

Proximal Femoral Locking Plate

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University of Virginia Orthopaedic Surgery

Post Op- 6 weeks

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13 mos post op

Persistent Lucency posteriorly Mild varus

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University of Virginia Orthopaedic Surgery

15 mos post injury Valgus IT osteotomy

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University of Virginia Orthopaedic Surgery

6 Yrs post injury

Minimal Pain Works manual labor job Minimal Shortening

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University of Virginia Orthopaedic Surgery

Literature

  • Early literature advocated immediate ORIF

within 8hrs

  • Not been reproduced
  • Current Opinion is obtain anatomic reduction

in timely fashion (wait for right team to be in place) but goal is < 24 hrs

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University of Virginia Orthopaedic Surgery

Summary

  • Challenging cases
  • Do not have to be done middle of night but

should be accomplished expeditiously

  • Need to be followed for 18+ months
  • Valgus IT osteotomy is good bailout for

nonunion

  • Know your limitations- refer to specialist if

needed

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Questions/Discussion