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Femoral Shaft Fractures
Posted: Apr 30 2022 #(C102042)
A

Open Femoral Shaft Fracture in 24M

HPI

A 24-year-old male that presents as a trauma after being involved in a motorcycle accident. He presents to the trauma bay with an obvious open wound on his right thigh and complaining of isolated right thigh pain. He denies any pain in any other extremities. No head trauma or loss of consciousness.

PMH

No significant past medical history

PE

A focused physical exam reveals a gross deformity at the right thigh with a 4x6 cm wound over the lateral aspect of the thigh and active bleeding. There is tenderness to palpation at the wound site. No tenderness to palpation at the knee or leg. Compartments are compressible. Sensation and motor are intact distally. Pulses are intact distally. CT scan was obtained and showed no femoral neck fracture.

Poll
1 of 12
1. In addition to AP and LAT radiographs of the femur (includes hip and knee joint), would you obtain any other imaging to guide management?
No - AP and LAT radiographs of the femur are sufficient
62%
498/798
Yes - additional radiographic views (aXR)
4%
36/798
Yes - CT scan of the hip/femur (CT)
27%
223/798
Yes - MRI scan of the hip/femur (MRI)
0%
4/798
Yes - aXR + CT
1%
14/798
Yes - aXR + MRI
0%
3/798
Yes - CT + MRI
0%
2/798
Yes - aXR + CT + MRI
0%
1/798
Other
0%
6/798
Outside my area of expertise - best if I don't vote
1%
11/798
2. Would you initiate antibiotics upon presentation, and if so which ones?
No - antibiotics are not indicated
1%
15/786
Yes - 1st generation cephalosporin (Ancef) only
38%
301/786
Yes - 1st generation cephalosporin + aminoglycoside
41%
329/786
Yes - 1st generation cephalosporin + aminoglycoside + penicillin
11%
88/786
Yes - Other combination
5%
44/786
Outside my area of expertise - best if I don't vote
1%
9/786
3. If you choose Operative management, would you do a Staged Procedure or a Single procedure?
I would not choose Operative management
0%
5/779
Staged Procedure - I would perform I&D without temporizing fixation as a first stage, followed by delayed definitive fixation
3%
24/779
Staged Procedure - I would perform I&D and temporizing fixation as a first stage, followed by delayed definitive fixation
24%
187/779
Single Procedure - I would perform irrigation and debridement (I&D) and definitive fixation in single setting
71%
555/779
Outside my area of expertise - best if I don't vote
1%
8/779
4. If you choose a Staged Procedure with temporizing fixation, what method would you use?
I would not choose a Staged Procedure with temporizing fixation
49%
368/740
Buck's external traction
1%
10/740
Skeletal traction - Distal Femoral Traction Pin
6%
51/740
Skeletal traction - Proximal Tibial Traction Pin
7%
54/740
Skeletal traction - Calcaneal Traction Pin
0%
5/740
External fixation
32%
238/740
Other
0%
3/740
Outside of my area of expertise - best if I don't vote
1%
11/740
5. If you choose Operative management, what definitive fixation would you perform?
I would not choose Operative management
0%
2/743
External fixation (ExFix) (includes monoplane, circular fixation)
0%
3/743
Open reduction and internal fixation (ORIF) with plates & screws
1%
14/743
Intramedullary nail fixation (IMN)
92%
685/743
IMN + ORIF (Nail/Plate Combo)
4%
34/743
Other
0%
1/743
Outside my area of expertise - best if I don't vote
0%
4/743
6. If you choose Intramedullary nail fixation (IMN), what approach would you use?
I would not choose IMN
0%
0/746
Antegrade - Trochanteric entry
63%
470/746
Antegrade - Piriformis entry
30%
229/746
Retrograde
5%
38/746
Outside my area of expertise - best if I don't vote
1%
9/746
7. If you choose Antegrade Intramedullary nail fixation (IMN), what type of implant would you use?
I would not choose Antegrade IMN Fixation
1%
9/723
Intramedullary nail - No head/neck fixation
58%
420/723
Cephallomedullary nail - Single head lag screw
17%
130/723
Cephallomedullary nail - Dual head screws (Recon nail)
21%
156/723
Cephallomedullary nail - Helical Blade
0%
0/723
Outside my area of expertise - best if I don't vote
1%
8/723
8. If you choose Antegrade Intramedullary nail fixation (IMN), how would you position this patient and which table would you use?
I would not choose Antegrade IMN
0%
6/703
Supine - Radiolucent flattop
14%
104/703
Supine - Fracture table
68%
485/703
Lateral - Radiolucent flattop
8%
61/703
Lateral - Fracture table
5%
42/703
Outside my area of expertise - best if I don't vote
0%
5/703
9. If you choose Antegrade Intramedullary nail fixation (IMN), would you perform Open reduction of the fracture site?
I would not choose Antegrade IMN
1%
12/692
No
27%
193/692
Yes
20%
141/692
Depends on quality of my closed reduction
49%
341/692
Outside my area of expertise - best if I don't vote
0%
5/692
10. If you choose Antegrade IMN Fixation and Open reduction of the fracture site, would you use any provisional fixation?
I would not choose Antegrade IMN Fixation and Open reduction
9%
66/663
No - No Provisional Fixation
75%
503/663
Yes - cerclage cables
5%
36/663
Yes - plate(s) and screws
5%
37/663
Yes - screw fixation alone
1%
7/663
Other
0%
5/663
Outside my area of expertise - best if I don't vote
1%
9/663
11. If you choose Antegrade IMN fixation of the femoral shaft fx, what would be your PRIMARY method to get your femoral ROTATION correct?
I would not choose Antegrade IMN fixation of the femoral shaft fx
0%
6/650
Intraop Nail - Use Inherent anteversion of intramedullary nail (Espinosa Technique)
2%
15/650
Intraop Open - Direct visualization of Fx reduction
17%
115/650
Intraop Fluoro - Cortical Thickness
30%
199/650
Intraop Fluoro - Lesser trochanter profile (LTP)
19%
124/650
Intraop Fluoro - Femoral neck horizontal angle (NHA)
1%
10/650
Intraop Fluoro - True lateral technique (TLT)
3%
23/650
Clinical Inspection - Look at direction foot is pointing vs. contralateral side
19%
126/650
Clinical Inspection - Look at skin wrinkling
0%
2/650
Other
1%
8/650
Outside my area of expertise - best if I don't vote
3%
22/650
12. If you choose Operative Management with IMN Fixation, how long after definitive fixation would you continue postoperative IV and Oral antibiotics?
I would not choose Operative Management with IMN Fixation
0%
0/645
No postop antibiotics
2%
17/645
1-2 days IV - No Oral abx
34%
224/645
1-2 days IV - 3-7 days Oral abx
21%
138/645
1-2 days IV - 8-14 days Oral abx
6%
42/645
3-5 days IV - No Oral abx
11%
77/645
3-5 days IV - 3-7 days Oral abx
9%
63/645
3-5 days IV abx - 8-14 days Oral abx
11%
72/645
Other
0%
3/645
Outside my area of expertise - best if I don't vote
1%
9/645
PROCEDURE #1 DOP: 4/8/2022

Right femur irrigation and debridement, open reduction and internal fixation

Intra-procedure P1
icon
OUTCOMES
Post-procedure P1
10 weeks after
Post-procedure P1
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