Posted: Nov 19 2021 #(C101856)

TKA Periprosthetic Fx in 83F

HPI

An 83-year-old female presents with right hip pain. The patient reports that she was walking to her car, dropped her keys, caught her foot on the curb of the sidewalk and landed on her right side. She had immediate deformity and pain to the right thigh. She denies any open wounds. The patient denies any other injuries including head trauma or LOC. She denies any numbness or tingling in her affected lower extremity. She denies previous pain in her right knee and hip prior to her fall.

PMH

Her past surgical history is notable for a right TKA for osteoarthritis and a right IMN s/p a intertrochanteric femur fracture. Her past medical history is notable for atrial fibrillation.

Focused physical examination of the right lower extremity demonstrates visible deformity at the right thigh. Circumferentially there are no open wounds or skin tenting. Sensation intact to light touch grossly. DP pulse are palpable. Capillary refill time is brisk. Motor exam is intact to EHL, FHL, TA, GS. Compartments are soft to palpation.

Poll

1 of 11

1. In addition to the plain film radiographs, would you obtain any additional imaging to guide management?

No - current radiographs are sufficient

32%

380/1152

Yes - addition radiographs (aXR)

41/1152

Yes - CT

55%

645/1152

Yes - MRI

8/1152

Yes - aXR + CT

39/1152

Yes - aXR + MRI

2/1152

Yes - CT + MRI

4/1152

Yes - aXR + CT + MRI

3/1152

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

30/1152

2. Would you use a classification system to help guide treatment of this injury?

No - a classification system would not help me

53%

585/1097

Yes - AO/OTA

11%

121/1097

Yes - Winquist

19/1097

Yes - Neer classification

6/1097

Yes - DiGioia and Rubash classification

6/1097

Yes - Chen classification

1/1097

Yes - Lewis and Rorabeck classification

66/1097

Yes - Su classification

36/1097

Yes - Vancouver classification

16%

178/1097

Yes - Other

5/1097

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

74/1097

3. How would you immobilize / place traction on this injury upon presentation?

I would not immobilize / place traction on this patient

16%

191/1140

Long leg posterior splint

19%

225/1140

Cutaneous traction (Buck's, Sager's)

43%

491/1140

Skeletal traction - Distal femur

43/1140

Skeletal traction - Proximal tibia

11%

128/1140

Skeletal traction - Calcaneus

40/1140

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

22/1140

4. How would you manage this injury?

Nonoperative

6/1118

Operative

98%

1100/1118

Outside my area of expertise

12/1118

5. If you choose Operative management, what procedure would you perform?

I would not choose Operative management

0/1120

External fixation (ExFix) (includes monoplane, circular fixation)

9/1120

Open reduction internal fixation (ORIF) only

54%

605/1120

Intramedullary nailing (IMN) only

17%

194/1120

ORIF + Intramedullary nailing (IMN)

25%

287/1120

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

25/1120

6. If you choose Intramedullary nailing (IMN) only, which procedure would you perform?

I would not choose IMN only

42%

450/1052

Antegrade IMN - following proximal implant removal

27%

293/1052

Retrograde IMN - leaving TKA, retaining proximal implant

82/1052

Retrograde IMN - leaving TKA, removing proximal implant

16%

174/1052

Retrograde IMN - revising TKA, retaining proximal implant

9/1052

Retrograde IMN - revising TKA, removing proximal implant

12/1052

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

32/1052

7. If you choose ORIF with Plate(s), which construct would you use?

I would not choose ORIF

10%

112/1043

Lateral plate fixation Alone

73%

769/1043

Medial plate fixation Alone

14/1043

Lateral + Medial plate fixation

11%

124/1043

Outside of my area of expertise - best I don't answer

24/1043

8. If you choose ORIF with Lateral plate fixation Alone, what approach would you use?

I would not chose ORIF with Lateral plate fixation Alone

79/1007

Lateral - Vastus splitting

24%

248/1007

Lateral - Subvastus (extensile, Bastia splitting)

27%

274/1007

Lateral - Submuscular plating (MIPO)

36%

372/1007

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

34/1007

9. If you chose ORIF with Lateral plate fixation Alone, what type of plate would you use?

I would not chose ORIF with Lateral plate fixation only

76/972

Blade plate - blade proximal

5/972

Blade plate - blade distal

5/972

Locking plate - Proximal femoral locking

68/972

Locking plate - Distal femoral locking

72%

705/972

Condylar buttress plate (non-locking)

19/972

Dynamic condylar screw

9/972

Large Fragment Plate

52/972

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

33/972

10. If you choose Open reduction internal fixation (ORIF) and obtained the construct shown below, what post-operative weight-bearing status would you assign the patient?

I would not choose the construct below

25/945

Non-weight-bearing (NWB)

41%

388/945

Touch down weight-bearing (TDWB)

38%

368/945

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

11%

107/945

Weight-bearing as tolerated (WBAT)

46/945

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

11/945

11. If you choose ORIF and obtained the construct below, what DVT prophylaxis would you prescribe?

I would not choose ORIF

10/933

Aspirin

16%

157/933

Low molecular weight heparin (Lovenox)

63%

590/933

Heparin transitioned to Coumadin

18/933

Xa inhibitors (Xarelto etc.)

15%

145/933

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

13/933

Intra-procedure P1

Post-procedure P1

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