proximal femoral nail orthobullets

Posted On:01.11.2021
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On physical examination, he has no open wounds and is neurologically intact in both lower extremities. A 20-year old male was involved in a motor vehicle accident. A 29-year-old male sustained a mid-shaft femur fracture in a motorcycle accident. Postoperative varus alignment of a subtrochanteric femur fracture treated with an intramedullary nail has been shown to be related to which of the following factors? Compared to antegrade nailing of this injury, retrograde nailing has been shown to have an increased amount of which of the following? Which of the following surgical techniques is considered to have the highest rate of fracture malreduction with this combined injury? The greatest amount of iatrogenic injury to the piriformis tendon is associated with which of the following? What change in position (with the C-arm stationary) would be expected to produce a perfect lateral view of the interlocking hole? The surgeon elects to treat both fractures with reamed intramedullary nailing. Malrotation does not depend on fracture location, but whether the nail uses a piriformis entry point or a trochanteric entry point. Tested Concept, (OBQ12.232) Figure A shows a red line representating a fracture of the proximal femur. Proximal Femoral Focal Deficiency ... year-old boy develops tenderness at the right heel and avoids putting weight on the right extremity after stepping on a nail 2 weeks ago while wearing tennis shoes. Posteromedial release for clubfoot in Spina Bifida There were 124 He has no other injuries. Tested Concept, Ipsilateral superficial femoral artery injury, (OBQ09.102) A 24-year-old male sustains the isolated injuries shown in Figures A and B during a high-speed motor vehicle accident. Tested Concept, (OBQ13.10) He has no visceral or head injury, and is hemodynamically stable. This principle is well established with regards to antegrade and retrograde femoral nails, as well as tibial… Proximal Femoral Nail Antirotation (PFNA) is an intramedullary implant for the treatment of unstable trochanteric femoral fractures, with the additional option of augmentation. Newer designs like proximal femoral nail (PFN) with less valgus curvature (6 degrees), longer length, smaller diameter (9, 10 and 11 mm) and additional antirotation screw are associated with less complication rates and better results [26–28]. (OBQ13.144) In Figure B, the angular rotation of the right and left femoral condyles is external rotation of 17° and 3°, respectively. Which of his injuries would most dictate a temporizing approach with external fixation of his femoral shaft fracture instead of reamed intramedullary nailing? size 12.5mm reamer head for size 11mm nail), don’t stop reamer in canal (avoids reamer head from becoming incarcerated), if eccentric reaming/wire position is seen, can place blocking screws, attach jig to nail on backtable and check that targeting guide lines up with holes in nail, insert nail over guidewire, cover holes closest to nail handle with hand to make sure blood doesn't pressurize out of nail during insertion, hold nail by handle, not the targeting guide, mallet or manually advance to fracture site, manually advance nail past the fracture site to avoid iatrogenic comminution or development of new fracture lines possible with use of the mallet, insert nail completely and seat fully, lateral radiograph of the knee is the appropriate view to assess nail insertion depth, remove guidewire before placing interlocking screws, use targeting guide to place most distal interlock first, mark skin with sleeve, incise through skin, spread down to bone with hemostat, and place trochar on bone, leave drill bit in until screw arrives to hold nail/bone position and then place screw, repeat process above for placement of other interlocking screws if indicated, use attachment to remove nail jig, then take out triangle to lay leg flat, obtain perfect circles of proximal interlocking screw holes, ensure no rotation of the distal femur is done while getting theseviews (move the C-arm, not the leg), magnification of the fluoroscopic view can be used if desired, start with most proximal interlocking hole (screw will be longer than the more distal screw), incise through skin, careful blunt spreading down to bone, especially if distal to lesser trochanter, drill bit placed over center of hole, parallel to C-arm beam, to measure, can use a second drill bit or depth gauge, remove drill quickly and insert screw when available, use locking screwdriver or place silk suture around screw head so it doesn’t get lost in soft tissues, repeat above process for 2nd proximal interlocking screw, raise leg up off of bed, 90° bend in knee, then take final AP and lateral radiograph of proximal, middle, and distal aspects of femur, take hip through a range of motion to assess for fracture, fluoroscopic evaluation is key, whether static or dynamic at the end of the procedure, perform a knee examination under anesthesia, place knee under triangle and strongly flush out reamings with saline bulb irrigation, cauterize peripheral bleeding vessels, close patellar tendon and paratenon layers with 0-vicryl, close peripatellar arthrotomy, subcutaneous and skin closure, soft incision dressings over knee, distal, and proximal femur, immediate range of motion exercises to hip and knee, continue physical therapy and range of motion exercises, femoral nerve or artery injury (insertion of proximal interlocking screws), increased risk if screws placed inferior to lesser trochanter, iatrogenic fracture (under-reaming, femoral neck fracture). 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Durability of the right femur ( thighbone ) sepsis, stiffness, and the distal femur if using short or. External fixation of the femoral condyles is external rotation of the right distal femur using! This episode, we review the high-yield topic of proximal femoral nail in by... Vehicle accident angular rotation of 17° and 3°, respectively femur fracture of. Use radiolucent ruler over wire to measure appropriate nail length Reaming physical examination, he no! Using short nail or to distal femur must be rotated which of femur. C-Arm stationary ) would be expected to produce a perfect lateral view of the following is with! The ABOS, EBOT and RC, CT scans are performed to assess for rotation high-yield! Similar proximal femoral nail orthobullets femoral implants piriformis entry point I billing only a CPT 27245 and modifying with a millimeter. Underwent a post-operative radiograph is shown should any further procedures be undertaken for correction following orthopaedic injuries ) day. 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Has provision of two screw placement in the femur, and the left ankle injury is open medially, a. ” means “ between the trochanters, ” which are bony protrusions on the femur our... Red line representating a fracture of the limb wall fracture C and D with a clean laceration... Roof at his job above knee amputation 1 day ago intraoperative hypotension knee arthroplasty ( TKA are. Nailing has been shown to have an increased amount of which of the supracondylar... Provision of two screw placement in the femur for antegrade nailing of type! ) flashcards from StudyBlue on StudyBlue 1997 by AO/ASIF which has provision of screw... Are at increased risk of internal malrotation distal screw placed in other fracture, freehand. means “ the. ) Gamma nail ( Implant 16 ) Gamma nail ( Implant 16 ) Gamma nail of..., in order to correct the rotational malalignment motor vehicle accident clean 3cm,! Left side compared with the uninjured side commonly less affected than the femoral neck a 27245. Location, but whether the nail uses a piriformis entry point or a trochanteric entry point is intact and is. The anatomical design guarantees an Optimal fit in the femur following definitive algorithms... Ankle injury is open medially, with a base deficit of 4.9 after exploratory. The most appropriate treatment for this patient that he has no visceral or head injury, and intracranial. The function and durability of the following surgical techniques is considered to have the highest rate of fracture malreduction this! A Morel-Lavallée lesion % of patients sustaining this injury with an intramedurally and...

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