Posted: Apr 14 2023 #(C102164) 2023 California Orthopaedic Association Annual Meeting

Femoral Neck Fracture in 53M

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HPI

A 53-year-old male presents to an outside hospital in the early morning, about 8 am, after a bicycle crash. He had immediate hip pain and an inability to ambulate. The patient was transferred to a trauma hospital at 830pm, about 12 hours after the injury, for definitive management. He is an avid cyclist and often does 100-mile rides.

PMH

No past medical history. The patient does not smoke tobacco or drink alcohol.

The affected hip was short and externally rotated. Painful to ROM. Neurovascularly intact distally.

Poll

1 of 13

1. In addition to AP and LAT radiographs of the injured hip, what additional imaging would you get to guide management?

None - AP and LAT radiographs are sufficient

28%

320/1107

Additional xrays (aXR)

29/1107

Hip CT (CT)

60%

674/1107

Hip MRI (MRI)

22/1107

aXR + CT

38/1107

aXR + MRI

4/1107

CT + MRI

5/1107

aXR + CT + MRI

3/1107

Outside my area of expertise - best if I don't vote

12/1107

2. If you choose Operative management, what surgical technique would you use?

I would not choose Operative management

7/1077

Fracture reduction internal fixation (FIX)

75%

817/1077

Total hip arthoplasty (THA)

18%

195/1077

Hemiarthroplasty (Hemi)

43/1077

Outside my area of expertise - best if I don't vote

15/1077

3. If you choose Fracture reduction internal fixation (FIX), and the patient arrived in the ER at 8:30 pm, with their last full meal at 2 pm, and is medically optimized, when would you perform surgery?

I would not choose Fracture reduction internal fixation (FIX)

69/1054

Same night (within 6 hours of arrival to ER)

41%

438/1054

Following morning first case, Bump elective cases, Cancel clinic if scheduled (12-24 hours)

40%

425/1054

Following day after elective cases, After clinic (24 - 32 hours)

80/1054

When convenient within 3 days from admission (OR available, don't change clinic, start before 5 pm)

25/1054

When convenient within 5 days from admission (OR available, don't change clinic, start before 5 pm)

3/1054

Outside my area of expertise - best if I don't vote

14/1054

4. If you choose Total hip arthoplasty (THA) and the patient arrived in the ER at 8:30 pm, with their last full meal at 2 pm, and is medically optimized, when would you perform surgery?

I would not choose THA

38%

375/986

Same night (within 6 hours of arrival to ER)

30/986

Following morning first case, Bump elective cases, Cancel clinic if scheduled (12-24 hours)

15%

153/986

Following day after elective cases, After clinic (24 - 32 hours)

26%

263/986

When convenient within 3 days from admission (OR available, don't change clinic, start before 5 pm)

13%

132/986

When convenient within 5 days from admission (OR available, don't change clinic, start before 5 pm)

22/986

Outside my area of expertise - best if I don't vote

11/986

5. If you choose Fracture reduction internal fixation (FIX), what Fracture Reduction technique would you use?

I would not choose Fracture reduction internal fixation (FIX)

69/988

Closed Reduction - Fluoro + Fx Table

58%

574/988

Closed Reduction - Percutaneous K-wires (joystick technique)

10%

100/988

Open Reduction - Watson Jones Approach

48/988

Open Reduction - Direct Anterior Approach

10%

105/988

Open Reduction - Direct Lateral Approach

63/988

Outside my area of expertise - best if I don't vote

29/988

6. If you choose Fracture reduction internal fixation (FIX), what fixation construct would you use?

I would not choose Fracture reduction internal fixation (FIX)

58/964

Cannulated screws only

49%

479/964

Dynamic/sliding hip screw

21%

210/964

Cephalomedullary nail

38/964

Proximal Femoral Locking Plate

14/964

Divergent Screw Plate System (e.g., FNS)

14%

143/964

Outside my area of expertise - best if I don't vote

22/964

7. If you choose Total hip arthroplasty (THA), what surgical approach would you use?

I would not choose THA

42%

403/939

Direct anterior

15%

145/939

Anterolateral

12%

113/939

Direct lateral

89/939

Posterolateral

18%

172/939

Outside my area of expertise - best if I don't vote

17/939

8. If you choose Total hip arthroplasty (THA), how would you address femoral reconstruction?

I would not choose THA

43%

400/911

Uncemented femoral stem

50%

462/911

Cemented femoral stem

37/911

Outside my area of expertise - best if I don't vote

12/911

9. If you choose Total hip arthroplasty (THA), what bearing articulation would you use?

I would not choose THA

35%

322/899

Metal-on-metal

7/899

Metal-on-polyethylene

10%

97/899

Ceramic-on-ceramic

88/899

Ceramic-on-polyethylene

32%

295/899

Dual mobility with a metal inner head

20/899

Dual mobility with a ceramic inner head

55/899

Outside my area of expertise - best if I don't vote

15/899

10. If you choose to THA, what technology would you use to optimize the position of the implants?

I would not choose THA

36%

311/863

None - Direct Visualization Alone

34%

300/863

Fluoroscopy (Fluoro) Alone

16%

142/863

Computer Assisted Navigation Alone (Nav)

23/863

Robot-Assisted Navigation (Robot)

35/863

Fluoro + Nav

17/863

Fluoro + Robot

6/863

Other Technology

3/863

Outside my area of expertise - best if I don't vote

26/863

11. If you choose Total hip arthroplasty (THA), and choose to Cement the femoral stem, would you use antibiotic-laden bone cement?

I would not choose Hemiarthroplasty or THA with a Cemented femoral stem

53%

442/832

Yes - I would use antibiotic-laden bone cement

23%

195/832

No - I would NOT use antibiotic-laden bone cement

21%

183/832

Outside my area of expertise - best if I don't vote

12/832

12. If you choose Total hip arthroplasty (THA), for how long would you prescribe DVT prophylaxis?

I would not choose Total hip arthroplasty

29%

253/855

I would not prescribe any DVT prophylaxis

9/855

1-2 weeks

57/855

3-4 weeks

35%

306/855

5-6 weeks

24%

208/855

7-8 weeks

8/855

9-10 weeks

1/855

11 weeks or greater

6/855

Outside my area of expertise - best if I don't vote

7/855

13. If you choose Operative management and attain the construct shown, how would you manage post-operative weight-bearing?

I would not choose Operative management

10/836

Non-weight bearing (NWB)

18%

155/836

Touch-down weight bearing (TDWB)

43%

364/836

Partial weight bearing (PWB, < 25-50%)

15%

129/836

Weight-bearing as tolerated (WBAT)

19%

165/836

Outside my area of expertise - best if I don't vote

13/836

Intra-procedure P1

1 day

Post-procedure P1

8 weeks

Post-procedure P1

7 months

Post-procedure P1

7 months

Post-procedure P1

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