Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

HPI

A 27-year-old male is involved in MVC at 50 mph.

PMH

N/A PMH Social ETOH

PE

RLE - inspection shows thigh swelling and deformity with ecchymosis - 2+ DP and PT pulse - 5/5 ankle DF/PF and EHL

Poll
1 of 14
1. Would you get additional imaging of the Femoral FX to determine treatment?
No - Current Xrays are sufficient
57%
1302/2271
Yes - Additional Xray views
18%
418/2271
Yes - CT scan
13%
313/2271
Yes - Additional Xray views + CT scan
8%
197/2271
Outside my area of expertise - best if I don't vote
1%
41/2271
2. Would you get additional imaging to rule out an Ipsilateral Femoral Neck FX?
No - Current Xrays are sufficient
50%
1071/2139
Yes - preop Additional Xray views ONLY
8%
179/2139
Yes - preop Fine-cut CT ONLY
14%
302/2139
Yes - preop Additional Xray views + Fine-cut CT
4%
92/2139
Yes - intraop Fluoroscopic views ONLY
11%
237/2139
Yes - preop Additional Xray views + intraop Fluoroscopic views
4%
96/2139
Yes - preop Additional Xray views + Fine-cut CT + intraop Fluoroscopic views
6%
130/2139
Outside my area of expertise - best if I don't vote
1%
32/2139
3. Would you use a classification system to guide your treatment of the femur fx?
No - a classification system does not help me determine treatment
64%
1353/2106
Yes - Winquist classification system
8%
169/2106
Yes - OTA classification system
23%
500/2106
Outside my area of expertise - best if I don't vote
3%
84/2106
4. How would you manage this patient?
Nonoperative - Skeletal traction until union
0%
7/2072
Operative
99%
2052/2072
Outside my area of expertise - best if I don't vote
0%
13/2072
5. If you chose Operative management, would you temporize this patient prior to definitive fixation?
I would not choose operative management
0%
9/2100
No - I would operate acutely (within 12 hours)
65%
1376/2100
Yes - temporize short-term with Buck's external traction
12%
264/2100
Yes - temporize short-term with Skeletal traction
18%
382/2100
Yes - temporize short/long term with External Fixation
1%
39/2100
Outside my area of expertise - best if I don't vote
1%
30/2100
6. If you choose to temporize with Skeletal Traction, what type would you use?
I would not temporize with Skeletal Traction
44%
911/2036
Distal Femoral Traction Pin
23%
488/2036
Proximal Tibial Traction Pin
28%
574/2036
Calcaneal Traction Pin
0%
17/2036
Outside my area of expertise - best if I don't vote
2%
46/2036
7. If you choose Operative management, what Definitive Fixation technique would you use?
I would not choose operative management
0%
0/2047
External fixation
0%
8/2047
Intramedullary nail fixation (IM Nail fixation)
94%
1937/2047
ORIF (plate, screws, wires)
1%
30/2047
IM Nail fixation + ORIF (plate, screws, wires)
2%
56/2047
Outside my area of expertise - best if I don't vote
0%
16/2047
8. If you choose IM Nail fixation or External fixation, would you perform Open Reduction of the fracture site?
I would not choose IM Nail fixation or External Fixation
0%
14/2013
No
87%
1762/2013
Yes
10%
208/2013
Outside my area of expertise - best if I don't vote
1%
29/2013
9. If you choose IM Nail fixation, what approach would you use?
I would not choose IM Nail fixation
0%
3/2023
Antegrade - Trochanteric entry
57%
1157/2023
Antegrade - Piriformis entry
32%
664/2023
Antegrade - Lateral entry
4%
88/2023
Retrograde
3%
66/2023
Outside my area of expertise - best if I don't vote
2%
45/2023
10. If you choose IM Nail fixation, how would you position the patient and what table would you use?
I would not choose IM Nail fixation
0%
4/1960
Lateral patient position - Fracture table
6%
129/1960
Lateral patient position - Radiolucent flattop table
6%
118/1960
Supine patient position - Fracture table
71%
1402/1960
Supine patient position - Radiolucent flattop table
13%
262/1960
Outside my area of expertise - best if I don't vote
2%
45/1960
11. If you choose IM Nail fixation, what would be your PRIMARY method to get your femoral LENGTH correct?
I would not choose IM Nail fixation
0%
2/1901
Preop Templating - Nail length using contralateral femur
17%
328/1901
Intraop Open - Direct visualization of Fx reduction
6%
124/1901
Intraop Fluoro - Imaging of Fx reduction
51%
972/1901
Intraop Flouro - Radiopaque ruler measurement vs. contralateral femur
16%
307/1901
Clinical inspection - Palpate plantar surface of foot/ankle vs. contralateral side
2%
49/1901
Clinical inspection - Measure length of leg vs contralateral side with string or ruler (Greater troch. to Lateral mal.)
3%
76/1901
Outside my area of expertise - best if I don't vote
2%
43/1901
12. If you choose IM Nail fixation, what would be your PRIMARY (most valuable) method to get your femoral ROTATION correct?
I would not choose IM Nail fixation
0%
2/1851
Preop Templating - Nail-screw angle vs. Contralateral
0%
16/1851
Intraop Fluoro - Cortical Thickness
26%
484/1851
Intraop Fluoro - Lesser trochanter profile (LTP)
28%
533/1851
Intraop Fluoro - Femoral neck horizontal angle (NHA)
4%
83/1851
Intraop Fluoro - True lateral technique (TLT)
8%
157/1851
Clinical Inspection - Look at direction foot is pointing vs. contralateral side
27%
500/1851
Clinical Inspection - Look at skin wrinkling
0%
7/1851
Outside my area of expertise - best if I don't vote
3%
69/1851
13. In this patient, if you choose IM Nail fixation, when would you begin FULL Weight Bearing as Tolerated?
I would not choose IM Nail fixation
0%
1/1857
Immediately
47%
873/1857
Wait 3 Days
3%
59/1857
Wait 1 Week
1%
19/1857
Wait 2 Weeks
4%
79/1857
Wait 3 Weeks
2%
48/1857
Wait 4 Weeks
7%
145/1857
Wait 6 Weeks
17%
334/1857
Wait 8 Weeks
4%
83/1857
Wait until Fx healing seen on xrays - then begin
9%
184/1857
Outside my area of expertise - best if I don't vote
1%
32/1857
14. In this patient, if you choose IM Nail fixation, how long would you prescribe postoperative DVT prophylaxis?
I would not choose IM Nail fixation
0%
2/1850
I would NOT prescribe DVT prophylaxis
7%
145/1850
Until the patient is ambulatory
18%
340/1850
1 week postop
4%
78/1850
2 - 4 weeks postop
43%
809/1850
5 - 7 weeks postop
21%
398/1850
8 - 10 weeks postop
1%
24/1850
11 - 12 weeks postop
0%
16/1850
Outside my area of expertise - best if I don't vote
2%
38/1850
PROCEDURE #1

Intramedullary Nailing of Right Femoral Shaft Fx

Intra-procedure P1
icon
OUTCOMES
Post-procedure P1
Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options