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Distal Femur Fractures
Posted: Sep 10 2020 #(C101580)
A

Distal Femur Fracture in a 75F

HPI

75-year-old female who presents to the ED for evaluation of left leg pain after sustaining a ground level fall. She reports she slipped in the bathroom, landing on the tile floor, and was unable to ambulate after the fall. Pain is localized to the left leg. Denies any other injuries.

PMH

HTN, DM2,

PE

Focused exam of the LLE: Obvious deformity and TTP about the distal femur, thigh compartments soft and compressible. DP/PT pulses 2+, symmetric. Motor intact EHL, FHL, GS. Sensation intact to all distributions of the foot.

Poll
1 of 9
1. In addition to the plain film radiographs, would you obtain any additional imaging to guide management?
No - current radiographs are sufficient
34%
481/1383
Yes - additional radiographic views (aXR)
4%
69/1383
Yes - CT scan of the femur (CT)
48%
677/1383
Yes - MRI scan of the femur (MRI)
0%
12/1383
Yes - aXR + CT
8%
116/1383
Yes - aXR + MRI
0%
2/1383
Yes - CT + MRI
0%
7/1383
Yes - aXR + CT + MRI
0%
2/1383
Outside my area of expertice, best if I do not answer
1%
17/1383
2. Would you use a classification system to guide management?
No - a classification system would not help me
49%
653/1321
Yes - AO/OTA
45%
605/1321
Yes - Other
0%
12/1321
Outside my area of expertise - best if I don't vote
3%
51/1321
3. How would you manage this injury?
Nonoperative
0%
2/1339
Operative
99%
1328/1339
Outside my area of expertice, best if I do not answer
0%
9/1339
4. If you choose Operative management, how would you definitely plan to manage this injury?
I would not choose Operative management
0%
0/1336
External fixation (ExFix) only (includes monoplanar, ringed circular fixation, etc)
0%
12/1336
Open reduction internal fixation (ORIF)
54%
725/1336
Intramedullary nail fixation (IMN) (includes percutaneous fixation)
33%
448/1336
ORIF + IMN
10%
136/1336
Outside my area of expertice, best if I do not answer
1%
15/1336
5. If you choose ORIF, what approach would you use?
I would not choose ORIF
8%
107/1308
Minimally invasive lateral
38%
498/1308
Standard open direct lateral approach
36%
475/1308
Modified anterior (Swashbuckler)
4%
54/1308
Lateral parapatellar
6%
85/1308
Medial parapatellar
2%
38/1308
Medial
0%
3/1308
Other
0%
8/1308
Outside my area of expertise, best if I do not answer
3%
40/1308
6. If you choose ORIF, what type of fixation would you plan to use?
I would not choose ORIF
5%
70/1284
Locking plate
85%
1094/1284
Non-locking plate
1%
17/1284
Blade plate
1%
25/1284
Dynamic condylar screw
2%
33/1284
Other
1%
16/1284
Outside my area of expertise, best if I do not answer
2%
29/1284
7. If you choose Operative management and attain the construct shown below, how would you immobilize the patient postoperatively?
I would not choose Operative management
0%
3/1199
Soft dressing only
46%
559/1199
Hinged knee brace
30%
363/1199
Knee immobilizer
16%
200/1199
Above-knee cast
4%
49/1199
Outside my area of expertise, best if I do not answer
2%
25/1199
8. If you choose Operative management and attain the construct shown below, when would you initiate weight-bearing post-operatively?
I would not choose Operative management
0%
0/1235
Immediately
11%
136/1235
2-4 weeks
11%
142/1235
5-6 weeks
35%
439/1235
7-8 weeks
23%
285/1235
9-12 weeks
13%
166/1235
>12 weeks
3%
45/1235
Outside my area of expertise, best if I do not answer
1%
22/1235
9. If you choose Operative management and attain the construct shown below, when would you initiate range of motion post-operatively?
I would not choose Operative management
0%
2/1212
Immediately
57%
695/1212
1-2 weeks
19%
242/1212
3-4 weeks
12%
155/1212
5-6 weeks
5%
71/1212
7-8 weeks
1%
19/1212
9-12 weeks
0%
9/1212
>12 weeks
0%
3/1212
Outside my area of expertise, best if I do not answer
1%
16/1212
PROCEDURE #1

Open reduction internal fixation

Intra-procedure P1
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OUTCOMES
Post-procedure P1
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