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Posted: Feb 18 2022 #(C102002)
C

Peritrochanteric Femur Fracture in 56M

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HPI

A 56-year-old male presents after sustaining a head-on MVC. Patient was a level 1 trauma transfer in hemorrhagic shock. Patient received 2 units of packed red blood cells in the trauma bay. Patient was the restrained front seat passenger in a head-on MVC on the highway. There is significant damage to the vehicle and required 45 minutes of extrication time. Patient has a history of chronic pain is on opiate medication at baseline. Patient complaining of pain to his right hip and right-sided ribs.

PMH

Depression, low back pain, GERD, Hypertension

PE

Focused exam of the left lower extremity demonstrates the right leg is shortened and externally rotated. Compartments are soft. No open wounds. Neurovascularly in tact distally.

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In addition to the plain film radiographs, would you obtain any other imaging to guide management?
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P: 146000
Would you use a classification system to guide management of this injury?
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P: 146001
How would you manage this injury?
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P: 146002
If you choose Operative management, would you temporize this patient prior to definitive fixation?
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P: 146005
If you choose Operative management and choose to temporize with Skeletal Traction, what type would you use?
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P: 146006
If you choose Intramedullary nail fixation (IMN), how would you position this patient?
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P: 146004
If you choose Operative management, what definitive fixation would you perform?
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P: 146007
If you choose IMN, would you perform open reduction of the fracture site?
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P: 146008
If you choose IMN and perform an open reduction of the fracture site, would you use any provisional fixation?
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P: 146009
If you choose IMN, what approach would you use?
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P: 146010
If you choose Intramedullary nail fixation (IMN), what type of implant would you use?
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P: 146011
If you choose Operative management and attained the construct shown below, what would your postoperative weight bearing protocol be?
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P: 146012
PROCEDURE #1

Cephalomedullary nail

Intra-procedure P1
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