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Distal Femur Fractures
Posted: Jun 21 2016 #(C2612)
A

Distal femur Periprosthetic Fx around IM Nail in 65F

HPI

Patient fell onto left knee and had immediate pain, swelling, and deformity. Unable to bear weight

PMH

Previous IM nail for a left IT fracture 3 years prior to presentation. Previous ORIF of a left tibial plateau fracture 10 years prior to presentation.

PE

Swollen left knee. Skin intact. NVI.

Poll
1 of 5
1. Based on the information provided, what do you think is the most likely cause for the fracture?
Osteoporosis / osteopaenia
47%
748/1578
Anterior cortical stress riser from IM nail
50%
798/1578
Infection
0%
5/1578
Tumor of distal femur (local or metastatic)
1%
27/1578
2. Would you obtain additional imaging studies before determining treatment?
No, xrays are enough
46%
780/1689
Yes, I would get a CT scan
50%
858/1689
Yes, I would get an MRI
1%
33/1689
Yes, I would get an MRI and CT scan
1%
18/1689
3. Based on the information provided, how would you treat this patient?
Nonoperative with reduction and immobilization
1%
23/1519
External Fixation
1%
26/1519
ORIF with plate fixation
83%
1270/1519
Retrograde nailing (following antegrade nail removal)
13%
200/1519
4. If performing ORIF, would you remove the intramedullary nail?
No, I would leave nail in
58%
871/1483
Yes, I would remove the IM nail prior to plate fixation
41%
612/1483
5. If performing ORIF, what plate construct would you use?
Single LATERAL plate - distal femoral periprosthetic fx plate
38%
564/1468
Single LATERAL plate - standard locking plate
27%
397/1468
DUAL plating - medial and lateral
12%
180/1468
Less invasive stabilization system (LISS) Plating
22%
327/1468
PROCEDURE #1

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