Intertrochanteric Femur Fracture in 91F

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PRESENTATION
3
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POLLS
14,798
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OUTCOMES
13
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VIDEOS
6
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EVIDENCE
60
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Comments
66
CASE DESCRIPTION
AGE 91 / Female
CC Left hip pain
HPI A 91-year-old female was found down in her room at an assisted living facility. She complains of left hip pain with the inability to bear weight. At baseline, she is able to walk with walker assistance.
PMH PMH: dementia and aortic stenosis
PE A focused physical examination of the left lower extremity reveals deformity of the leg including shortening and external rotation. There is pain at the hip with any movement of the leg. Sensation and motor are intact distally and 2+ pulses are present in the foot.
Pre-procedure IMAGES:
https://upload.orthobullets.com/cases/102056/3aa84fef-464e-4420-a8a6-5ef3f36f3ce1_preop_3..jpg https://upload.orthobullets.com/cases/102056/543855a4-1b2e-40af-a6a7-74a464fe6531_preop_1..jpg https://upload.orthobullets.com/cases/102056/e49e7217-0b55-4e73-a8f9-6a2ca822f6e1_preop_2..jpg
POLLS
OB Community
1) In addition to plain film radiographs, would you obtain any further imaging to guide your treatment?
Other
2) Would you use a classification system for this injury to guide management?
Other
3) How would you manage this injury?
Other
4) If you choose Operative management, and this patient presented to the ER at 4 pm, when would you do the surgery (assuming patient is cleared for surgery)?
Other
5) If you choose Operative management, what procedure would you plan to perform?
Other
6) If you choose Open Reduction and Internal Fixation (ORIF), what construct would you choose?
Other
7) If you choose Cephallomedullary nail (CMN), how would you position the patient and what table would you use?
Other
8) If you choose Cephallomedullary nail (CMN), what length nail would you select?
Other
9) If you choose Cephallomedullary nail (CMN), what type of proximal fixation would you use?
Other
10) If you choose Cephallomedullary nail (CMN), what would be your PRIMARY (most valuable) method to get your femoral ROTATION correct?
Other
11) If you choose Cephallomedullary nail (CMN) and obtain the construct shown below, what postoperative weight-bearing status would you assign the patient?
Other
12) If you choose Operative management and attained the construct shown below, what chemical anticoagulation would you use postoperatively?
Other
CASE OUTCOMES
PROCEDURE 1: Left femur CEPHALOMEDULLARY NAILING, CPT 27245
Intra-procedure P1
https://upload.orthobullets.com/cases/102056/fdfb315c-df35-47ad-8e81-774972d3f6b4_intraop_1..jpg https://upload.orthobullets.com/cases/102056/ce9ce7fa-e4d5-42a0-9ebf-a35ad272a2f8_intraop_2..jpg https://upload.orthobullets.com/cases/102056/290045c9-3225-4a46-8e00-f40729874e46_intraop_3..jpg https://upload.orthobullets.com/cases/102056/e01873e3-75f5-40ba-95f2-def1e5fb5adf_intraop_4..jpg https://upload.orthobullets.com/cases/102056/0d59b6f0-1e1c-4bdb-a673-ec6282d02473_intraop_5..jpg https://upload.orthobullets.com/cases/102056/562193c2-722e-465a-9183-0fd36024ae7c_intraop_6..jpg https://upload.orthobullets.com/cases/102056/b474e730-6a40-42e7-9969-309340372d3d_intraop_7..jpg https://upload.orthobullets.com/cases/102056/b72dd13d-11f2-4b41-b7c2-4c3e85aea750_intraop_8..jpg https://upload.orthobullets.com/cases/102056/229bb0dc-71bd-4a9a-8d53-91d7041be9a7_intraop_9..jpg https://upload.orthobullets.com/cases/102056/9ccb5252-1e9f-4af8-b0c7-85c9ce08176b_intraop_10..jpg https://upload.orthobullets.com/cases/102056/9e71d284-15ca-4a85-82d3-0b2a09588568_intraop_11..jpg
Post-procedure P1
https://upload.orthobullets.com/cases/102056/04e70249-c8be-45ab-a7b3-2a5e27289977_postop_1..jpg https://upload.orthobullets.com/cases/102056/e80b5f44-e106-4358-8aae-f452c94715e5_postop_2..jpg
VIDEOS & PODCASTS (6)
EVIDENCE (60)
EXPERT COMMENTS