Subtrochanteric Femur Fractures: 5 Tips in 5 Minutes Bob Zura. MD - - PowerPoint PPT Presentation

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Subtrochanteric Femur Fractures: 5 Tips in 5 Minutes Bob Zura. MD - - PowerPoint PPT Presentation

May 22, 2023 580 likes •965 views

Subtrochanteric Femur Fractures: 5 Tips in 5 Minutes Bob Zura. MD LSU New Orleans OSET 2017 Las Vegas Disclosures Consultant: Smith-Nephew Bioventus Cardinal Health Subtrochanteric Femur Fractures Fractures within 5cm of

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Subtrochanteric Femur Fractures: 5 Tips in 5 Minutes

Bob Zura. MD LSU New Orleans OSET 2017 Las Vegas

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Disclosures

  • Consultant:

– Smith-Nephew – Bioventus – Cardinal Health

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Subtrochanteric Femur Fractures

  • Fractures within 5cm of

lesser trochanter

  • Bimodal

– Young – high energy – Elderly – low energy and periprosthetic

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Deformity

  • Muscular Attachments

– Inbalance after injury causes deformity – Proximal:

  • Iliopsoas flexion and external

rotation

  • Short abductors - abduction

– Distal:

  • Adductor magnus
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Surgery

  • This is easy

– 1. Reduce the fracture – 2. Apply an appropriate implant

  • Occasionally, these 2 events occur

concurrently

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But you must……

REDUCE THE FRACTURE!

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Tip #1: Go Lateral

  • Easier to reduce
  • Easier to Nail
  • Easier to open
  • Better for Fatties
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Tip #2: Nail When you can

  • Nails are just Better
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Method of Reduction - Nail

  • Küntscher Technique:

– to reduce proximal femoral fractures. The

  • live-tipped guidewire

can be passed through the repositioning equipment to the distal fragment.

  • Rockwood and Green
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But…nails are not always so easy

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Tip #3: The Right Starting Point!

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Nail - Starting Point

  • Tip of the Trochanter

– Avoid varus! – In line with posterior cortex on lateral – Helps correct flexion – Not too anterior

  • Avoid blowout
  • Piriformis is still allowed

too!!!

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Starting Point

  • Critical because you do not want……
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Extension

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Varus

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Comminution

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Tip #4: Use Tricks to Reduce

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Retained plate

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Tip#5: Revise with the Opposite

  • If bad plate – use Nail
  • If bad Nail – use plate
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To assist with Complications

  • 38 yo healthy contractor
  • 6’3”, 250 lbs
  • Injured skiing
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  • Treated with OIF locally
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  • Bonus Tip 5.5:
  • DON’T TRUST YOUR

FLUORO

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4 year follow-up

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Bonus Tip

Tip#6: Don’t forget the Blade!

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Tip #4 in action!

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These are very hard fractures!!!

GOOD LUCK!