Subtrochanteric Fractures Pathway Posted: 2/19/2022 ID: (C102003)

Open Subtrochanteric Femur Fx s/p GSW in 48M

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PRESENTATION
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POLLS
10,806
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OUTCOMES
7
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VIDEOS
3
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EVIDENCE
26
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Comments
25
CASE DESCRIPTION
AGE 48 / Male
CC Left hip pain
HPI A 48-year-old male presents after a GSW to the left thigh. He reports being in his auto shop when he was assaulted by unknown individuals. He was shot in the left thigh and sustained blunt trauma to his head. He denies any loss of consciousness. Denies blood thinner use. The patient denies any numbness or tingling to the ipsilateral lower extremity. The remainder of the exam is unremarkable.
PMH Obesity, HTN, HLD
PE A focused physical exam of the left lower extremity demonstrates external rotation positioning of the left leg. There is an open wound to the anterior proximal thigh with oozing blood present. He has pain with logrolling of the hip and has TTP to proximal femur, traveling down into the distal thigh. Compartments are soft to palpation. He is neurovascularly intact.
Pre-procedure IMAGES:
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POLLS
OB Community
1) In addition to the plain film radiographs, would you obtain any other imaging to guide management?
Other
2) Would you use a classification system to guide management of this injury?
Other
3) How would you manage this injury?
Other
4) If you choose Operative management, assuming the patient arrived in the ER at 7 pm, when would you perform surgery?
Other
5) If you choose Operative management, would you temporize this patient prior to definitive fixation?
Other
6) If you choose Operative management and choose to temporize with Skeletal Traction, what type would you use?
Other
7) If you choose Operative management, what definitive fixation would you perform?
Other
8) If you choose Intramedullary nail fixation (IMN), how would you position this patient?
Other
9) If you choose IMN, would you perform open reduction of the fracture site?
Other
10) If you choose IMN and perform an open reduction of the fracture site, would you use any provisional fixation?
Other
11) If you choose IMN, what approach would you use?
Other
12) If you choose Intramedullary nail fixation (IMN), what type of implant would you use?
Other
CASE OUTCOMES
PROCEDURE 1: Recon intramedullary nail left femur
Intra-procedure P1
https://upload.orthobullets.com/cases/102003/85fdf506-b3fb-4177-9f5a-d02709cc397f_capture5.jpg https://upload.orthobullets.com/cases/102003/f93e9a9d-14be-4063-9603-e5224ba0b0dd_capture6.jpg https://upload.orthobullets.com/cases/102003/a6b3bee1-f22f-4f53-9626-9df8fc6f2d22_capture7.jpg https://upload.orthobullets.com/cases/102003/a4fd984d-cf0e-4cd3-b1f7-550427e5117e_capture8.jpg https://upload.orthobullets.com/cases/102003/de46fa78-339e-487d-8c50-0b14ff0adfa1_capture9.jpg https://upload.orthobullets.com/cases/102003/31648e61-8356-4015-8f01-065b37edcce2_capture10.jpg https://upload.orthobullets.com/cases/102003/960ea3ea-6122-46f1-bffd-dac23cca04e2_capture12.jpg
VIDEOS & PODCASTS (3)
EVIDENCE (26)
EXPERT COMMENTS