• flexible titanium nails
• length unstable fx (comminuted or spiral)
• very proximal or distal fx
• any weight
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Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC.
An 8-year-old male was seen in the emergency department with his parents after being struck by a car while riding his bicycle. He was found to have the injury seen in Figure A. Which of the following treatment modalities is most appropriate for treating this injury?
Piriformis entry femoral nail
Flexible intramedullary nail
ORIF with plate and screws
Trochanteric entry femoral nail
Select Answer to see Preferred Response
For which of the following patients is Pavlik harness treatment appropriate?
4-month-old with a diaphyseal femur fracture and a neuromuscular disorder with lower extremity spasticity
4-month-old with a displaced spiral mid-diaphyseal femur fracture
4-month-old with a diaphyseal femur fracture and concomitant closed head injury and chest trauma
9-month-old with a diaphyseal femur fracture with <2cm shortening
9-month-old with a diaphyseal femur fracture with >2cm shortening
Submuscular bridge plating is appropriate treatment for which of the following?
A 2-month-old female with displaced, spiral, mid-diaphyseal femur fracture
A 26-month-old boy with a displaced spiral mid-diaphyseal femur fracture with <2cm shortening
A 7-year old boy with a transverse, non-comminuted mid-diaphyseal femur fracture
A 7-year-old boy with a highly comminuted mid-diaphyseal femur fracture
A 15-year-old girl with a displaced butterfly fragmented mid-diaphyseal femur fracture
A 3-year-old male sustains the injury shown in Figure A and an immediate hip spica is placed. Over the next 24-hours the patient is noted to become agitated with increasing analgesia requirements and decreased movement of his left toes. All of the following factors may lead to this condition EXCEPT:
Spica casting with knee flexed 105-degrees
Immediate cast placement in the emergency department under conscious sedation
Initial placement of short leg cast for traction to aid in fracture reduction
Firm cast mold in popliteal fossa to prevent fracture displacement
High energy injury
Titanium elastic nailing is appropriate treatment for which of the following?
A 10-year-old boy who weighs 35 kilograms with a highly comminuted diaphyseal femur fracture
A 10-year-old boy who weighs 35 kilograms with a transverse, mid-diaphyseal femur fracture
A 10-year-old boy who weighs 51 kilograms with a transverse, mid-diaphyseal femur fracture
Immediate spica casting is most appropriate for which of the following?:
2-month-old girl with a displaced spiral mid-diaphyseal femur fracture
A 26-month-old boy with a displaced spiral mid-diaphyseal femur fracture with <2 centimeters of shortening
3-day-old with teratologic right hip dislocation
9-year-old boy with a displaced spiral mid-diaphyseal femur fracture
12-year-old girl weighing 90 pounds with a displaced spiral mid-diaphyseal femur fracture
Antegrade rigid intramedullary nailing with a trochanteric entry nail is appropriate for which of the following?
Which of the following techniques used to treat pediatric femur fractures has been associated with the greatest risk of damage to the deep branch of the medial femoral circumflex artery?
An 11-year-old female sustains an open right femoral shaft fracture and closed left both-bone forearm fracture after being struck by a motor vehicle. She is 5'1'' and weighs 146 lbs. No neurovascular deficits are noted in any of her extremities. Which of the following is a contraindication to elastic intramedullary nail fixation of her femur fracture?
Multiple extremity fractures
Open femur fracture
An 11-year-old male falls and sustains the injury shown in Figure A. Which of the following treatment options carries the greatest risk of injury to the medial femoral circumflex artery (MFCA)?
Femoral nail with piriformis starting point
Femoral nail with trochanteric starting point
Intramedullary flexible nails
Retrograde intramedullary nailing
External fixation with trochanteric fixation proximal
Which of the following patients would be the BEST candidate for submuscular bridge plating?
A 4-year-old boy with a spiral diaphyseal femur fracture
A 9-year-old, 75-lb girl with a length stable distal one-third femur fracture
A 10-year-old, 120-lb boy with a long spiral, comminuted midshaft femur fracture
A 17-year-old girl with an open, transverse midshaft femur fracture
An 18-year-old female with a proximal third, wedge-shaped femur fracture
Figure 22 shows the radiograph of a 7-year-old boy who underwent retrograde elastic nailing of a femoral shaft fracture. What is the most common problem following this procedure?
Osteonecrosis of the femoral head
Persistent pain and irritation at the nail insertion site
A 14-year-old boy sustains a femoral shaft fracture while waterskiing. He is treated with a piriformis fossa entry antegrade intramedullary nail. Six months post-operatively the patient complains of persistent groin pain. What is the most likely complication he has sustained?
iatrogenic femoral neck fracture
femoral head osteonecrosis
femoral shaft non-union
proximal locking screw cutout
A 9-year-old girl presents to the emergency department after a MVC. She was found to have an initial GCS of 3 at the scene of the accident but improved to a GCS of 12 on arrival to the trauma bay. She is found to have a closed head injury and a right transverse femoral shaft fracture, shown in Figure A. Shortly after her arrival to the hospital, she is cleared for surgery and brought to the operating room for intramedullary nailing of her femur fracture using flexi nails (Figure B). Compared to delayed treatment, early treatment of the patient's femur fracture is most likely to lead to which of the following outcomes?
Increased risk of ARDS
Decreased long-term mental function
Increased risk of pneumonia
No increased risk of pulmonary complications
No difference in length of hospital stay
A 4-year-old boy sustains a midshaft femur fracture with less than 2 cm of shortening that was treated with immediate closed reduction and hip-spica casting. Of the following listed potential complications, which is the most common requiring revision treatment in this age group?
loss of reduction
A 7-year-old boy sustains an isolated, closed injury shown in Figure A. He weighs 55lbs and is otherwise healthy. What is the best treatment option for this patient?
Closed reduction and hip spica casting
Closed reduction and flexible intramedullary nailing
Closed reduction and antegrade rigid femoral intramedullary nailing
Skeletal traction and hip spica casting
A 13-year-old male is involved in motor vehicle accident. He has a GCS of 6 and is intubated at the scene. He has a splenic laceration that will require an emergent exploratory laparotomy and he has a left hemothorax requiring a chest tube. His femur fracture is shown in Figure A. What is the next best step in management of this fracture?
Balanced skeletal traction
Intramedullary nail with trochanteric starting point
Intramedullary nail with pirifomis starting point