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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%
499/799
Yes - additional radiographic views (aXR)
4%
36/799
Yes - CT scan of the hip/femur (CT)
27%
223/799
Yes - MRI scan of the hip/femur (MRI)
0%
4/799
Yes - aXR + CT
1%
14/799
Yes - aXR + MRI
0%
3/799
Yes - CT + MRI
0%
2/799
Yes - aXR + CT + MRI
0%
1/799
Other
0%
6/799
Outside my area of expertise - best if I don't vote
1%
11/799
2. Would you initiate antibiotics upon presentation, and if so which ones?
No - antibiotics are not indicated
2%
16/787
Yes - 1st generation cephalosporin (Ancef) only
38%
301/787
Yes - 1st generation cephalosporin + aminoglycoside
41%
329/787
Yes - 1st generation cephalosporin + aminoglycoside + penicillin
11%
88/787
Yes - Other combination
5%
44/787
Outside my area of expertise - best if I don't vote
1%
9/787
3. If you choose Operative management, would you do a Staged Procedure or a Single procedure?
I would not choose Operative management
0%
6/780
Staged Procedure - I would perform I&D without temporizing fixation as a first stage, followed by delayed definitive fixation
3%
24/780
Staged Procedure - I would perform I&D and temporizing fixation as a first stage, followed by delayed definitive fixation
23%
187/780
Single Procedure - I would perform irrigation and debridement (I&D) and definitive fixation in single setting
71%
555/780
Outside my area of expertise - best if I don't vote
1%
8/780
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%
368/741
Buck's external traction
1%
11/741
Skeletal traction - Distal Femoral Traction Pin
6%
51/741
Skeletal traction - Proximal Tibial Traction Pin
7%
54/741
Skeletal traction - Calcaneal Traction Pin
0%
5/741
External fixation
32%
238/741
Other
0%
3/741
Outside of my area of expertise - best if I don't vote
1%
11/741
5. If you choose Operative management, what definitive fixation would you perform?
I would not choose Operative management
0%
2/744
External fixation (ExFix) (includes monoplane, circular fixation)
0%
4/744
Open reduction and internal fixation (ORIF) with plates & screws
1%
14/744
Intramedullary nail fixation (IMN)
92%
685/744
IMN + ORIF (Nail/Plate Combo)
4%
34/744
Other
0%
1/744
Outside my area of expertise - best if I don't vote
0%
4/744
6. If you choose Intramedullary nail fixation (IMN), what approach would you use?
I would not choose IMN
0%
0/747
Antegrade - Trochanteric entry
63%
471/747
Antegrade - Piriformis entry
30%
229/747
Retrograde
5%
38/747
Outside my area of expertise - best if I don't vote
1%
9/747
7. If you choose Antegrade Intramedullary nail fixation (IMN), what type of implant would you use?
I would not choose Antegrade IMN Fixation
1%
9/724
Intramedullary nail - No head/neck fixation
58%
421/724
Cephallomedullary nail - Single head lag screw
17%
130/724
Cephallomedullary nail - Dual head screws (Recon nail)
21%
156/724
Cephallomedullary nail - Helical Blade
0%
0/724
Outside my area of expertise - best if I don't vote
1%
8/724
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%
6/704
Supine - Radiolucent flattop
14%
104/704
Supine - Fracture table
69%
486/704
Lateral - Radiolucent flattop
8%
61/704
Lateral - Fracture table
5%
42/704
Outside my area of expertise - best if I don't vote
0%
5/704
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%
12/693
No
27%
193/693
Yes
20%
141/693
Depends on quality of my closed reduction
49%
342/693
Outside my area of expertise - best if I don't vote
0%
5/693
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%
66/664
No - No Provisional Fixation
75%
504/664
Yes - cerclage cables
5%
36/664
Yes - plate(s) and screws
5%
37/664
Yes - screw fixation alone
1%
7/664
Other
0%
5/664
Outside my area of expertise - best if I don't vote
1%
9/664
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%
6/651
Intraop Nail - Use Inherent anteversion of intramedullary nail (Espinosa Technique)
2%
15/651
Intraop Open - Direct visualization of Fx reduction
17%
115/651
Intraop Fluoro - Cortical Thickness
30%
199/651
Intraop Fluoro - Lesser trochanter profile (LTP)
19%
124/651
Intraop Fluoro - Femoral neck horizontal angle (NHA)
1%
11/651
Intraop Fluoro - True lateral technique (TLT)
3%
23/651
Clinical Inspection - Look at direction foot is pointing vs. contralateral side
19%
126/651
Clinical Inspection - Look at skin wrinkling
0%
2/651
Other
1%
8/651
Outside my area of expertise - best if I don't vote
3%
22/651
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%
0/646
No postop antibiotics
2%
17/646
1-2 days IV - No Oral abx
34%
224/646
1-2 days IV - 3-7 days Oral abx
21%
139/646
1-2 days IV - 8-14 days Oral abx
6%
42/646
3-5 days IV - No Oral abx
11%
77/646
3-5 days IV - 3-7 days Oral abx
9%
63/646
3-5 days IV abx - 8-14 days Oral abx
11%
72/646
Other
0%
3/646
Outside my area of expertise - best if I don't vote
1%
9/646
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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