Posted: Jul 20 2020 #(C101537)

Interprosthetic Femur Fracture in 74F

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HPI

Fall from standing height, tripped over carpet. Lives with brother, ambulates with a wheeled walker. Has pain at the left knee and hip. Denies numbness/tingling/weakness, denies pain elsewhere.

PMH

PMH: CVA with left sided deficits, provoked DVT on eliquis, HTN, HLP, OA, breast cancer PSH: Left hip hemiarthroplasty, left total knee arthroplasty, cataracts, mastectomy Social: Denies tobacco, alcohol, illicits, community ambulator with a cane

Physical exam of her LLE shows: Inspection: Open wound at base of fifth toe on left foot. No skin breakdown on left knee. Palpation: TTP at distal femur, compartments soft and compressible. Neuro exam: Intact motor to EHL, FHL, TA, GS complex. Sensation grossly intact to S, Sa, T, Dp, Sp nerves. Vascular: DP pulse is palpable. Capillary refill time is less than 3 seconds.

Poll

1 of 10

In addition to AP and LAT radiographs of the knee and femur, would you obtain additional imaging to guide management?

1 No - AP and LAT radiographs of knee and femur are sufficient

2 Yes - Additional radiographic views (aXR)

3 Yes - CT scan of the femur (CT)

4 Yes - MRI scan of the femur (CT)

5 Yes - CT + aXR

6 Yes - MRI + aXR

7 Yes - MRI + CT

8 Yes - MRI + CT + aXR

9 Outside of my area of expertise - best I don't answer

Other

Submit

P: 118716

Would you use a classification system to guide management?

1 No - a classification system would not help me

2 Yes - Neer classification

3 Yes - DiGioia and Rubash classification

4 Yes - Chen classification

5 Yes - Lewis and Rorabeck classification

6 Yes - Su classification

7 Yes - Vancouver classification

8 Yes - Other

9 Outside my area of expertise - best if I don't vote

Other

Submit

P: 118718

How would you manage this patient?

1 Nonoperative

2 Operative

3 Outside my area of expertise - best I don't answer

Other

Submit

P: 118033

If you choose Operative management, what is the PRIMARY method by which would you assess implant stability?

1 I would not choose Operative management

2 I would NOT assess implant stability - it would not change my management

3 Pre-operative imaging (includes stress films, CT scan)

4 Intra-operative imaging (includes fluoroscopic stress films)

5 Intra-operative direct visualization of bone-implant interface

6 Outside my area of expertise - best if I don't vote

Other

Submit

P: 118832

If you choose Operative management, which surgery would you perform?

1 I would not choose Operative management

2 Open reduction internal fixation (ORIF)

3 Intramedullary nail fixation (IMN)

4 ORIF + IMN

5 Revision Arthroplasty (includes supplementary fixation)

6 Outside of my area of expertise - best I don't answer

Other

Submit

P: 118727

If you choose Open reduction internal fixation (ORIF), which construct would you use?

1 I would not choose ORIF

2 Lateral plate fixation only

3 Lateral + medial plate fixation

4 Other

5 Outside of my area of expertise - best I don't answer

Other

Submit

P: 118035

If you choose Lateral plate fixation, what approach would you use?

1 I would not choose Lateral plate fixation

2 Minimally invasive plate osteosynthesis (MIPO)

3 Extensile lateral approach

4 Outside my area of expertise - best if I don't vote

Other

Submit

P: 118831

If you choose Lateral plate fixation, what type of plate would you select?

1 I would not choose Lateral plate fixation

2 Condylar buttress plate (non-locking)

3 Locking supracondylar/periarticular plate (locking)

4 Blade plate

5 Dynamic condylar screw

6 Outside my area of expertise - best if I don't vote

Other

Submit

P: 118834

If you choose Lateral plate fixation, what fixation would you use proximally?

1 I would not choose Lateral plate fixation

2 Screws only

3 Cables only

4 Cables + Screws

5 Outside of my area of expertise - best I don't answer

Other

Submit

P: 118833

If you choose Open reduction internal fixation (ORIF) and attain the construct shown below, when would you permit the patient to bear weight?

1 I would not choose ORIF

2 Immediately

3 3-4 weeks

4 5-6 weeks

5 7-8 weeks

6 9-12 weeks

7 >12 weeks

8 Outside my area of expertise - best if I dont vote

Other

Submit

P: 118037

Intra-procedure P1

Post-procedure P1

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