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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%
1306/2284
Yes - Additional Xray views
18%
421/2284
Yes - CT scan
13%
316/2284
Yes - Additional Xray views + CT scan
8%
198/2284
Outside my area of expertise - best if I don't vote
1%
43/2284
2. Would you get additional imaging to rule out an Ipsilateral Femoral Neck FX?
No - Current Xrays are sufficient
49%
1075/2151
Yes - preop Additional Xray views ONLY
8%
180/2151
Yes - preop Fine-cut CT ONLY
14%
304/2151
Yes - preop Additional Xray views + Fine-cut CT
4%
93/2151
Yes - intraop Fluoroscopic views ONLY
11%
238/2151
Yes - preop Additional Xray views + intraop Fluoroscopic views
4%
96/2151
Yes - preop Additional Xray views + Fine-cut CT + intraop Fluoroscopic views
6%
132/2151
Outside my area of expertise - best if I don't vote
1%
33/2151
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%
1358/2118
Yes - Winquist classification system
8%
170/2118
Yes - OTA classification system
23%
504/2118
Outside my area of expertise - best if I don't vote
4%
86/2118
4. How would you manage this patient?
Nonoperative - Skeletal traction until union
0%
8/2084
Operative
98%
2062/2084
Outside my area of expertise - best if I don't vote
0%
14/2084
5. If you chose Operative management, would you temporize this patient prior to definitive fixation?
I would not choose operative management
0%
9/2112
No - I would operate acutely (within 12 hours)
65%
1382/2112
Yes - temporize short-term with Buck's external traction
12%
268/2112
Yes - temporize short-term with Skeletal traction
18%
382/2112
Yes - temporize short/long term with External Fixation
1%
39/2112
Outside my area of expertise - best if I don't vote
1%
32/2112
6. If you choose to temporize with Skeletal Traction, what type would you use?
I would not temporize with Skeletal Traction
44%
914/2048
Distal Femoral Traction Pin
24%
492/2048
Proximal Tibial Traction Pin
28%
578/2048
Calcaneal Traction Pin
0%
17/2048
Outside my area of expertise - best if I don't vote
2%
47/2048
7. If you choose Operative management, what Definitive Fixation technique would you use?
I would not choose operative management
0%
0/2059
External fixation
0%
8/2059
Intramedullary nail fixation (IM Nail fixation)
94%
1948/2059
ORIF (plate, screws, wires)
1%
30/2059
IM Nail fixation + ORIF (plate, screws, wires)
2%
56/2059
Outside my area of expertise - best if I don't vote
0%
17/2059
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%
14/2025
No
87%
1772/2025
Yes
10%
208/2025
Outside my area of expertise - best if I don't vote
1%
31/2025
9. If you choose IM Nail fixation, what approach would you use?
I would not choose IM Nail fixation
0%
3/2034
Antegrade - Trochanteric entry
57%
1162/2034
Antegrade - Piriformis entry
32%
667/2034
Antegrade - Lateral entry
4%
88/2034
Retrograde
3%
67/2034
Outside my area of expertise - best if I don't vote
2%
47/2034
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%
4/1972
Lateral patient position - Fracture table
6%
129/1972
Lateral patient position - Radiolucent flattop table
6%
119/1972
Supine patient position - Fracture table
71%
1409/1972
Supine patient position - Radiolucent flattop table
13%
263/1972
Outside my area of expertise - best if I don't vote
2%
48/1972
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%
2/1913
Preop Templating - Nail length using contralateral femur
17%
329/1913
Intraop Open - Direct visualization of Fx reduction
6%
124/1913
Intraop Fluoro - Imaging of Fx reduction
51%
977/1913
Intraop Flouro - Radiopaque ruler measurement vs. contralateral femur
16%
309/1913
Clinical inspection - Palpate plantar surface of foot/ankle vs. contralateral side
2%
49/1913
Clinical inspection - Measure length of leg vs contralateral side with string or ruler (Greater troch. to Lateral mal.)
4%
78/1913
Outside my area of expertise - best if I don't vote
2%
45/1913
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%
2/1863
Preop Templating - Nail-screw angle vs. Contralateral
0%
16/1863
Intraop Fluoro - Cortical Thickness
26%
485/1863
Intraop Fluoro - Lesser trochanter profile (LTP)
28%
536/1863
Intraop Fluoro - Femoral neck horizontal angle (NHA)
4%
84/1863
Intraop Fluoro - True lateral technique (TLT)
8%
159/1863
Clinical Inspection - Look at direction foot is pointing vs. contralateral side
26%
502/1863
Clinical Inspection - Look at skin wrinkling
0%
7/1863
Outside my area of expertise - best if I don't vote
3%
72/1863
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%
1/1869
Immediately
47%
879/1869
Wait 3 Days
3%
59/1869
Wait 1 Week
1%
19/1869
Wait 2 Weeks
4%
80/1869
Wait 3 Weeks
2%
48/1869
Wait 4 Weeks
7%
145/1869
Wait 6 Weeks
17%
336/1869
Wait 8 Weeks
4%
83/1869
Wait until Fx healing seen on xrays - then begin
9%
185/1869
Outside my area of expertise - best if I don't vote
1%
34/1869
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%
2/1861
I would NOT prescribe DVT prophylaxis
7%
145/1861
Until the patient is ambulatory
18%
345/1861
1 week postop
4%
78/1861
2 - 4 weeks postop
43%
812/1861
5 - 7 weeks postop
21%
399/1861
8 - 10 weeks postop
1%
24/1861
11 - 12 weeks postop
0%
16/1861
Outside my area of expertise - best if I don't vote
2%
40/1861
PROCEDURE #1

Intramedullary Nailing of Right Femoral Shaft Fx

Intra-procedure P1
icon
OUTCOMES
Post-procedure P1
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