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

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 Orthopaedic Surgery

You are on call • And it’s Christmas Eve • What should you do? • Fix? – When? • Replace? • Transfer? • Phone a Friend? University of Virginia Orthopaedic Surgery

Injury Films University of Virginia Orthopaedic Surgery

Selected CT cuts Typical Deformity- Anterior tension failure with posterior comminution University of Virginia Orthopaedic Surgery

Selected CT cut University of Virginia Orthopaedic Surgery

Classification • Pauwel’s – Based on verticality of fracture line through neck – Shearing forces increase as type does University of Virginia Orthopaedic Surgery

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

ORIF SOH ….Save Our Hip 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 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) University of Virginia Orthopaedic Surgery

Proximal Femoral Locking Plate University of Virginia Orthopaedic Surgery

Post Op- 6 weeks University of Virginia Orthopaedic Surgery

13 mos post op Persistent Lucency posteriorly Mild varus University of Virginia Orthopaedic Surgery

15 mos post injury Valgus IT osteotomy University of Virginia Orthopaedic Surgery

6 Yrs post injury Minimal Pain Works manual labor job Minimal Shortening 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 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 University of Virginia Orthopaedic Surgery

Questions/Discussion University of Virginia Orthopaedic Surgery