Femur fractures OSET Simon C. Mears, MD, PhD University of - - PowerPoint PPT Presentation

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Femur fractures OSET Simon C. Mears, MD, PhD University of - - PowerPoint PPT Presentation

Sep 30, 2023 507 likes •749 views

Femur fractures OSET Simon C. Mears, MD, PhD University of Arkansas for Medical Sciences 21yoF CC: R leg pain HPI: received hoverboard for Christmas present. Upon first use fell onto right side, could not walk, obvious deformity, otherwise

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Femur fractures

OSET Simon C. Mears, MD, PhD University of Arkansas for Medical Sciences

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21yoF

CC: R leg pain HPI: received hoverboard for Christmas present. Upon first use fell onto right side, could not walk, obvious deformity, otherwise healthy woman Exam: leg with gross thigh deformity, no open wounds, NVI distally

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Presentation xray

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Treatment options

  • Low energy trauma
  • Resuscitated
  • Intramedullary fixation

– Antegrade vs retrograde? – Nail entry? – Positioning?

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Antegrade trochanteric entry nail

  • n fracture table

Narrow femoral canal 9mm nail No obvious femoral neck fracture Lachman test negative Rotation even

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3 month followup

Doing well, Clinically and radiographically healed

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25 year old man

CC: gunshot to right femur HPI: low caliber gun, isolated injury to right thigh PMHx: none Exam: alert, +dp/pt pulses, strong foot motion and intact sensation. Unable to move leg

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Injury films

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Treatment options

Retrograde nail Plate fixation

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Distal femoral locking plate

Indirect reduction

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3 month followup

Allowed immediate weight bearing and range of motion

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Failed hip fracture

  • 80 yo woman with previous hip fracture 11 months ago.

Has had problems ever since surgery. Formally very active real estate agent. Since then limited walking

  • Now with 1 week of severe pain in groin and inability to

ambulate

  • PMH/PSH: previous stroke, vertigo, fibromyalgia, takes

Plavix and aspirin

  • Exam: Leg is shortened and rotated, very painful to motion,

unable to weight bear

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Presentation xrays

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Options

  • Workup?
  • Type of stem?
  • What about the cup?
  • Problems with conversion from IM nail?
  • Stability?
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Postop: Hybrid total hip replacement

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Postop course

  • Cultures negative at day 5
  • Mobilized, WBAT
  • Dc to rehab center POD 3
  • Doing very well at 3 months, walking with

cane, getting back to selling houses

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LM is a 73 y.o. year old female patient who was transferred from OSH after falling in her kitchen and c/o knee pain She reports she has had both knees and both hips replaced. Fall Thursday Transferred at 1 am Saturday

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Medical history

  • HTN
  • CAD w/ stent placement 15 years ago
  • Pacemaker (placed in 2007, last checked in

08/2015)

  • GERD
  • Carotid artery disease s/p CEA 2003
  • Chronic back pain due to spinal stenosis which

she has taken daily Percocet for the last 5 years.

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Options??

  • ORIF
  • Revision TKA
  • What to do about Hip replacement above??
  • Medicine : Cardiovascular - normal exam,

Exercise tolerance: 4 METS or >

  • Maximized for surgery
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Postop

  • Mobilized WBAT
  • POD 3 dc’ed to sisters house (No SNF)
  • Seen at 6 weeks: 0-120 motion, walking well
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