Page 965 - TNFlipTest

Toronto Notes 2019 Femur
Treatment
• non-operative
■ closed reduction: external abduction splint to prevent hip adduction (most often)
• operative
■ indication: 2 or more dislocations with evidence of polyethylene wear, malalignment, hardware
failure
■ revision THA
■ conversion to hemiarthroplasty with a larger femoral head
■ resection arthroplasty is a last resort
Complications
• sciaticnervepalsyin25%(10%permanent) • HO
• infection
Femur
Femoral Diaphysis Fracture
Mechanism
• highenergytrauma(MVC,fallfromheight,gunshotwound)
■ pathologic as a result of malignancy, osteoporosis, bisphosphonate use
• inchildren,canresultfromlowenergytrauma(spiralfracture)
Clinical Features
• shortened,externallyrotatedleg(iffracturedisplaced) • inabilitytoweight-bear
• oftenopeninjury,alwaysaGustiloIII(Table6)
• WinquistandHansenclassification
Investigations
• X-ray:APpelvis,AP/lateralhip,femur,knee
Treatment
• non-operative(uncommon)
■ indication: non-displaced femoral shaft fractures in co-morbid patients ■ long leg cast
• operative
■ ORIF with anterograde IM nail (most common) or retrograde IM nail; external fixator for unstable
patients, open fractures, or highly vascular areas; or plate and screws for open growth plates within
24h
■ early mobilization and strengthening
Complications
• bloodloss
• fatembolismleadingtoARDS
• extensivesofttissuedamage
• ipsilateralhipdislocation/fracture(2-6%) • nerveinjury
Distal Femoral Fracture
• fracturesfromarticularsurfaceto5cmabovemetaphysealflare
Mechanism
• directhighenergyforceoraxialloading
• threetypes:extraarticular,partialarticular,completearticular
Clinical Features
• extremepain
• kneeeffusion(hemarthrosis)
• neurovasculardeficitscanoccurwithdisplacedfracture
Investigations
• X-ray: AP, lateral
• CT,angiographyifdiminishedpulses
Orthopedics OR31
DVT Prophylaxis in Elective THA
(continue 10-35 d post-operative) Fondaparinux, low molecular weight heparin, or warfarin
It is important to rule out ipsilateral femoral neck fracture, as they occur in 2-6% of femoral diaphysis fractures and are reportedly missed in 19-31% of cases
Supracondylar
Condylar
Intercondylar Figure 37. Distal femoral fractures
© Paul Belletrutti 2003