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Distal Femur Fractures
Posted: Apr 2 2016 #(C2552)
A

Open Distal Femur Fracture in 38M

HPI

Fall from height with injury to the right knee. Unable to stand or move the knee.

PMH

none

PE

Significant swelling about the knee with a small puncture wound over the anterior aspect, no range of motion secondary to pain, otherwise neurovascularly intact distally with no other injuries.

Poll
1 of 10
1. How would you classify this injury if you used a classification system?
33.C1 (AO/OTA)
10%
141/1319
33.C2 (AO/OTA)
26%
345/1319
33.C3 (AO/OTA)
32%
425/1319
I would classify with a system different than AO/OTA
5%
76/1319
I would not classify, it does not help guide treatment
18%
245/1319
Outside my area of expertise - best if I don't vote
6%
87/1319
2. Considering he has a small puncture wound over the knee, how would you determine if it is an open or closed injury?
Inspect and explore wound to see if it communicates with joint
18%
256/1388
Obtain CT scan - it will tell me if it is open or closed
8%
117/1388
Perform a saline load test WITHOUT methylene blue dye
10%
146/1388
Perform a saline load test WITH methylene blue dye
7%
106/1388
Does not matter if open or closed, I am operating and exploring/washing out joint anyhow
53%
739/1388
Outside my area of expertise - best if I don't vote
1%
24/1388
3. Would you perform the I&D at the same time as definitive fixation or stage them?
Stage them - I would perform I&D immediately then fixation in second procedure later
16%
213/1320
Same Procedure - I would perform I&D and fixation during the same operation
82%
1083/1320
Outside my area of expertise - best if I don't vote
1%
24/1320
4. What Type of treatment would you use following I&D and IV Abx?
External Fixation (as definitive management)
3%
40/1309
Retrograde IM Nailing
9%
121/1309
ORIF with Plating
86%
1127/1309
Outside my area of expertise - best if I don't vote
1%
21/1309
5. If performing ORIF with Plating, what surgical approach would you use?
Anterolateral
35%
464/1299
Lateral parapatellar
40%
528/1299
Medial parapatellar
3%
50/1299
Combination (two approaches)
16%
219/1299
Outside my area of expertise - best if I don't vote
2%
38/1299
6. If performing ORIF with Plating, what plate fixation technique would you use?
Open distal femoral Locking plate fixation
52%
663/1252
MIPO distal femoral Locking plate fixation
32%
411/1252
Open Non-fixed Angle Plate fixation
1%
21/1252
MIPO Non-fixed Angle Plate fixation
1%
18/1252
Dynamic Condylar Screw plate fixation
6%
77/1252
Blade Plate fixation
0%
6/1252
Outside my area of expertise - best if I don't vote
4%
56/1252
7. If you chose Retrograde Nailing, would you use screws to augment the reduction and help nail placement?
No - Retrograde IM Nailing Alone
3%
37/1188
Yes - I would place distal screws PRIOR to Retrograde IM Nailing
36%
435/1188
Yes - I would place distal screws AFTER Retrograde IM Nailing
5%
69/1188
I would not perform Retrograde IM Nailing
52%
620/1188
Outside my area of expertise - best if I don't vote
2%
27/1188
8. When performing your articular reduction and fixation, would you include an arthrotomy to visualize your articular reduction?
Yes
69%
826/1195
No- fluoroscopy is satisfactory
29%
351/1195
Outside my area of expertise - best if I don't vote
1%
18/1195
9. If you obtain the fixation in the radiographs below, when would you begin partial weight bearing?
Immediately
7%
88/1175
2 Weeks
4%
48/1175
4 Weeks
10%
121/1175
6 Weeks
51%
607/1175
2 Months
16%
189/1175
3 Months
7%
92/1175
> 3 Months
1%
15/1175
Outside my area of expertise - best if I don't vote
1%
15/1175
10. How long would you place this patient on pharmacologic DVT prophylaxis for?
I would NOT place this patient on pharmacologic DVT prophylaxis
7%
94/1198
2 Weeks
15%
188/1198
4 Weeks
29%
350/1198
6 Weeks
34%
418/1198
2 Months
5%
67/1198
3 Months
5%
61/1198
> 3 Months
0%
3/1198
Outside my area of expertise - best if I don't vote
1%
17/1198
PROCEDURE #1

NO DESCRIPTION

Intra-procedure P1
PROCEDURE #2 DOP: 3/24/2016

orif intrarticular with distal femur plate mippo

icon
OUTCOMES
Post-procedure P1
15 months after
Post-procedure P2
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