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TKA Periprosthetic Fracture
Posted: Nov 19 2021 #(C101856)
A

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.

PE

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
33%
385/1166
Yes - addition radiographs (aXR)
3%
41/1166
Yes - CT
56%
653/1166
Yes - MRI
0%
8/1166
Yes - aXR + CT
3%
39/1166
Yes - aXR + MRI
0%
2/1166
Yes - CT + MRI
0%
4/1166
Yes - aXR + CT + MRI
0%
3/1166
Outside my area of expertise - best if I don't vote
2%
31/1166
2. Would you use a classification system to help guide treatment of this injury?
No - a classification system would not help me
53%
592/1109
Yes - AO/OTA
11%
123/1109
Yes - Winquist
1%
19/1109
Yes - Neer classification
0%
6/1109
Yes - DiGioia and Rubash classification
0%
6/1109
Yes - Chen classification
0%
1/1109
Yes - Lewis and Rorabeck classification
5%
66/1109
Yes - Su classification
3%
37/1109
Yes - Vancouver classification
16%
179/1109
Yes - Other
0%
5/1109
Outside my area of expertise - best if I don't vote
6%
75/1109
3. How would you immobilize / place traction on this injury upon presentation?
I would not immobilize / place traction on this patient
16%
194/1152
Long leg posterior splint
19%
227/1152
Cutaneous traction (Buck's, Sager's)
42%
495/1152
Skeletal traction - Distal femur
3%
43/1152
Skeletal traction - Proximal tibia
11%
128/1152
Skeletal traction - Calcaneus
3%
42/1152
Outside my area of expertise - best if I don't vote e
1%
23/1152
4. How would you manage this injury?
Nonoperative
0%
6/1130
Operative
98%
1111/1130
Outside my area of expertise
1%
13/1130
5. If you choose Operative management, what procedure would you perform?
I would not choose Operative management
0%
0/1131
External fixation (ExFix) (includes monoplane, circular fixation)
0%
10/1131
Open reduction internal fixation (ORIF) only
53%
610/1131
Intramedullary nailing (IMN) only
17%
195/1131
ORIF + Intramedullary nailing (IMN)
25%
290/1131
Outside my area of expertise - best if I don't vote
2%
26/1131
6. If you choose Intramedullary nailing (IMN) only, which procedure would you perform?
I would not choose IMN only
42%
453/1063
Antegrade IMN - following proximal implant removal
28%
298/1063
Retrograde IMN - leaving TKA, retaining proximal implant
7%
82/1063
Retrograde IMN - leaving TKA, removing proximal implant
16%
176/1063
Retrograde IMN - revising TKA, retaining proximal implant
0%
9/1063
Retrograde IMN - revising TKA, removing proximal implant
1%
12/1063
Outside my area of expertise - best if I don't vote
3%
33/1063
7. If you choose ORIF with Plate(s), which construct would you use?
I would not choose ORIF
10%
114/1055
Lateral plate fixation Alone
73%
777/1055
Medial plate fixation Alone
1%
14/1055
Lateral + Medial plate fixation
11%
125/1055
Outside of my area of expertise - best I don't answer
2%
25/1055
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
7%
80/1018
Lateral - Vastus splitting
24%
249/1018
Lateral - Subvastus (extensile, Bastia splitting)
27%
278/1018
Lateral - Submuscular plating (MIPO)
36%
375/1018
Outside my area of expertise - best if I don't vote
3%
36/1018
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
7%
77/984
Blade plate - blade proximal
0%
5/984
Blade plate - blade distal
0%
5/984
Locking plate - Proximal femoral locking
7%
70/984
Locking plate - Distal femoral locking
72%
712/984
Condylar buttress plate (non-locking)
1%
19/984
Dynamic condylar screw
0%
9/984
Large Fragment Plate
5%
52/984
Outside my area of expertise - best if I don't vote
3%
35/984
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
2%
25/957
Non-weight-bearing (NWB)
41%
394/957
Touch down weight-bearing (TDWB)
38%
371/957
Partial weight bearing (PWB, < 25-50%)
11%
107/957
Weight-bearing as tolerated (WBAT)
4%
47/957
Outside my area of expertise - best if I don't vote
1%
13/957
11. If you choose ORIF and obtained the construct below, what DVT prophylaxis would you prescribe?
I would not choose ORIF
1%
10/946
Aspirin
16%
160/946
Low molecular weight heparin (Lovenox)
63%
597/946
Heparin transitioned to Coumadin
1%
18/946
Xa inhibitors (Xarelto etc.)
15%
146/946
Outside my area of expertise - best if I don't vote
1%
15/946
PROCEDURE #1

Open reduction internal fixation (ORIF) with Lateral plate fixation only.

Intra-procedure P1
icon
OUTCOMES
Post-procedure P1
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