Summary Intertrochanteric Fractures are common extracapsular fractures of the proximal femur at the level of the greater and lesser trochanter that are most commonly seen following ground-level falls in the elderly population. Diagnosis is made with orthogonal radiographs of the hip. MRI is most helpful to evaluate occult hip fractures. Treatment is generally operative with sliding hip screw versus cephalomedullary nail depending on fracture stability. Epidemiology Incidence account for ~50% of hip fractures 150,000 intertrochanteric fractures per year in US 500 per 100,000 population per year for elderly female 200 per 100,000 population per year for elderly male Demographics age average ~80 years old typically older age than femoral neck fractures female: male ratio between 2:1 and 8:1 Risk factors proximal humerus fractures increase risk of hip fracture for 1 year osteoporosis advancing age increased number of comorbidities increased dependency with ADLs Etiology Pathophysiology mechanism elderly low energy falls in osteoporotic patients young high energy trauma Associated conditions osteoporosis recurrent falls dementia parkinsons unsteady gait visual impairment medications Anatomy Osteology neck shaft angle 130 +/- 7 degrees anteversion 10 +/- 7 degrees intertrochanteric area exists between greater and lesser trochanters calcar femorale vertical wall of dense bone that extends from posteromedial aspect of femoral shaft to posterior portion of femoral neck level of involvement helps determine stable versus unstable fracture patterns radius of curvature of femur average 114-120 cm factors that decrease radius of curvature (increased bowing) elderly asian short stature Muscles deforming forces on proximal segment flexion iliopsoas sartorius rectus femoris pectineus external rotation piriformis superior gemellus obturator internus inferior gemellus quadratus femoris abduction gluteus maximus gluteus medius gluteus minimus tensor fascia lata deforming forces on distal segment adduction and shortening adductor longus adductor brevis adductor magnus gracilis overall varus alignment Blood supply rich collateral circulation reduces risk of nonunion trochanteric anastomosis ascending branch of medial circumflex femoral artery (MFCA) ascending branch of lateral circumflex femoral artery (LFCA) deep branch of superior gluteal artery inferior gluteal artery transverse branch of LFCA and MFCA periosteum and surrounding muscles Biomechanics Ward's triangle area of lowest BMD in femoral neck bordered by 3 main compressive/tensile trabeculae primary compressive trabeculae extends from medial femoral head along calcar and excellent support to proximal femur vertically oriented with a triangular configuration principal tensile trabeculae forms an arc through the superior cortex of the femoral head and neck extends from greater trochanter to inferior aspect of femoral head below fovea secondary compressive trabeculae fan-like configuration crossing from greater trochanter to lesser and also comprises calcar Classification Stability most commonly used and reliable classification two types stable definition intact posteromedial cortex clinical significance will resist medial compressive loads once reduced unstable definition fracture will collapse into varus or shaft will displace medially examples large or comminuted posteromedial cortex i.e. lesser trochanteric fragment reverse obliquity or transtrochanteric fracture line extending from medial cortex out through lateral cortex subtrochanteric extension other considerations lateral wall thickness measured from 3 cm distal from innominate tubercle at 135 degrees to the fracture site <20.5 mm suggest risk of postoperative lateral wall fracture should be treated with cephalomedullary nail (CMN) rather than sliding hip screw (SHS) key role in stabilizing proximal femur by providing lateral buttress AO/OTA Classification 31A -A1 peritrochanteric simple two part intact lateral cortex 31A-A2 pertrochanteric with separate posteromedial fragment intact lateral cortex 31A-A3 fracture extends through lateral and medial cortex Evans classification (based on post-reduction stability) Stable fracture posteromedial cortex intact or minimal comminution able to resist compressive loads Unstable fracture greater comminution of posteromedial cortex can be converted to a stable pattern if medial cortical opposition obtained Reverse obliquity unstable due to medial displacement of femoral shaft due to adductors Presentation History mechanism of injury low-energy most common in elderly higher-energy may be associated with other injuries pre-injury functional status predictor of postoperative functional status antecedent hip pain presence of OA or pathological fracture history of anticoagulation factors into surgical timing list of comorbidites (ASA classification) Symptoms acute onset of hip pain inability to ambulate Physical Exam inspection shortened, externally rotated lower extremity palpation tenderness over greater trochanter motion pain with log roll and axial load unable to perform active straight leg raise assess thigh compartments neurovascular assessment Imaging Radiographs recommended views AP pelvis AP hip cross table lateral full length femur optional traction internal-rotation view improve accuracy of fracture classification with direct impact on surgical planning findings AP pelvis compare to contralateral hip and assess neck shaft angle AP hip defines fracture pattern cross-table lateral helps assess for posterior cortex comminution full length femur assess subtrochanteric extension possibility of pathological fracture estimate length of intramedullary nail assess femoral bowing assess canal diameter CT indication second line imaging to evaluate for occult fracture no access or contraindication to MRI views thin, 1-2 mm slice cuts diagnostic accuracy sensitivity 86% specificity 98% MRI indication occult hip fracture AAOS recommendation: moderate strength isolated greater trochanteric fracture to evaluate for intertrochanteric extension findings bone marrow edema STIR or fat-suppressed T2 line of decreased intensity on T1 coronal view corresponding with signal on T2 and STIR diagnostic accuracy sensitivity T1-weighted 100% (most sensitive) T2-weighted 84% Bone scan indication contraindication to MRI rarely used improved access to MRI and CT delay in care false negative up to 72 hours from injury diagnosis accuracy variable with sensitivity up to 98% Treatment Nonoperative indications nonambulatory patients high risk for perioperative mortality skin breakdown at surgical site incomplete fractures modalities non-weight bearing with early mobilization from bed to chair outcomes high mortality rate 84.4% at 1-year higher rates of pneumonia, UTI, decubitus ulcers, and DVT low risk of displacement with occult fracture Operative intramedullary hip screw (cephalomedullary nail) indications stable fracture patterns AAOS recommendation: strong for use of either SHS or CMN unstable fracture patterns AAOS recommendation: strong for use of CMN reverse obliquity fractures AAOS recommendation: strong for use of CMN 56% failure rate when treated with SHS subtrochanteric extension AAOS recommendation: strong for use of CMN lack of integrity of femoral wall associated with increased displacement and collapse when treated with SHS increased risk of lateral wall fracture with decreasing lateral wall thickness technique short CMN long CMN outcomes stable fracture pattern similar clinical and radiographic outcomes for SHS vs CMN unstable fracture pattern lower reoperation rate with CMN CMN use has significant increased over last decade open reduction and internal fixation (ORIF) indications stable fracture pattern AAOS recommendation: strong for use of either SHS or CMN techniques sliding hip compression (SHS) screw (most common) proximal femur locking plate 95 degree blade plate (rarely used) outcomes similar outcomes for stable fracture patterns when compared to CMN arthroplasty indications (rare) salvage for failed internal fixation severely comminuted fractures preexisting severe degenerative hip arthritis severely osteoporotic bone that is unlikely to hold internal fixation Techniques Intramedullary hip screw (cephalomedullary nail) pros biologically friendly with potentially closed technique less estimated blood loss (EBL) can be used in unstable fracture patterns decreased bending strain on implant load sharing device with shorter lever arm on implant intramedullary buttress limits shaft medialization cons periprosthetic fracture higher implant cost than sliding hip screw violation of hip abductors for insertion approach supine on fracture table lateral decubitus on radiolucent table technique short vs long CMN controversial AAOS recommendation: limited short CMN advantage ease of use decreased OR time decreased EBL lower implant cost long CMN advantage theoretical benefit of protecting entire femur disadvantage increased OR time increased EBL increased radiation exposure possible mismatch of implant bow and femur outcomes similar functional outcomes, peri-implant fracture, and cutout rate short nail can tolerate up to 3 cm of subtrochanteric extension lag screw versus helical blade controversial lag screw proven track record femoral head rotation during insertion helical blade theoretical benefit of compacting cancellous bone around blade during insertion avoids removal of bone with reamer biomechanical studies showing higher cutout resistance complication lag screw or helical blade cutout anterior perforation of femur perimplant fracture Open reduction and internal fixation Sliding hip compression screw technique must obtain correct neck-shaft relationship lag screw with tip-apex distance <25 mm is associated with reduced failure rates 4 hole plates show no benefit clinically or biomechanically over 2 hole plates pros allows dynamic interfragmentary compression lower implant cost no violation of hip abductors cons open technique increased blood loss not advisable in unstable fracture patterns excessive fracture collapse limb shortening medialization of shaft anterior spike malreduction in left-sided, unstable fractures due to screw torque place derotational wire or screw prior to lag screw insertion proximal femoral locking plate indication infrequently used consider in young patient with unstable fracture pros allow for intraoperative fracture compression avoid excessive postoperative fracture compression maintain limb length avoid shaft medicalization cons limited evidence highly dependent on surgeon experience must obtain anatomic reduction Arthroplasty technique long stem with calcar-replacing prosthesis often needed must attempt fixation of greater trochanter to shaft pros possible early return to unrestricted weight bearing not reliant on internal fixation in osteoporotic bone cons increased blood loss and OR time increased cost may require prosthesis that some surgeons are less familiar with Complications Implant failure and cutout incidence occurs in 4-20% usually occurs within first 4 months risk factors older age osteoporosis fracture type quality of reduction tip-apex distance (TAD) sum of distances from tip of lag screw to apex of femoral head on AP and lateral after adjusting for magnification goal TAD <25mm TAD >45 mm associated with 60% failure rate treatment young corrective osteotomy and/or revision open reduction and internal fixation elderly or articular injury from screw cutout total hip arthroplasty Nonunion and malunion incidence <2% uncommon due to good blood supply leads to varus collapse and screw cutout diagnosis hip pain with persistent radiolucent defect at fracture site 4-7 months after surgery CT scan may help confirm diagnosis rule out infection treatment valgus intertrochanteric osteotomy + bone grafting arthroplasty screw cutout has damaged hip joint Peri-implant fracture incidence 1-3% at 1 year no significant difference between short and long CMN short CMN typically fracture just distal to tip of nail long CMN typically fracture more around the rod (as opposed to the tip) risk factors distal interlocking screw protective against fracture treatment short CMN distally inserted lateral femoral plate with cables revise to long CMN long CMN closed reduction and insertion of distal locking screw distal femoral plating (fracture distal to tip) Anterior perforation of the distal femur incidence mostly seen with insertion of long CMN decreased with improvements in nail radius of curvature to better match patient anatomy risk factors mismatch of the radius of curvature of the femur (shorter) and implant (longer) posterior starting point on the greater trochanter Postoperative anemia and transfusions blood transfusion >30% postoperative transfusion rate AAOS moderate recommendation transfusion threshold no higher than 8g/dL in asymptomatic postop hip fracture transexamic acid (TXA) AAOS strong recommendation for use decrease EBL decrease postoperative blood transfusion Prognosis Mortality 15-30% mortality risk in the first year following fracture 84.4% at one year with nonoperative treatment Factors that increase mortality male gender (25-30% mortality) vs female (20% mortality) higher in intertrochanteric fracture (vs femoral neck fracture) operative delay of >2 days age >85 years 2 or more pre-existing medical conditions ASA classification (ASA III and IV increases mortality) Factors that decrease mortality Surgery within 48 hours decreases 1 year mortality AAOS moderate recommendation for hip fracture surgery pithing 24-48 hours of admission early medical optimization and co-management with medical hospitalists or geriatricians AAOS strong recommendation for use of interdisciplinary care teams Loss of independence community-dwelling ambulators at 1-year 41% maintain pre-injury ambulatory status 40% more dependent on assistive devices 12% became household ambulators 8% became nonfunctional ambulators One-third general rule 1/3 regain function 1/3 lose one level of independence 1/3 mortality rate
Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Intertrochanteric Fracture ORIF with Cephalomedullary Nail Orthobullets Team Trauma - Intertrochanteric Fractures Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Femoral Neck Fracture ORIF with Dynamic Hip Screw Orthobullets Team Trauma - Femoral Neck Fractures
QUESTIONS 1 of 29 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (SBQ18TR.2) What is the most cost-effective implant indicated for the injury shown in Figures A and B, assuming the hospital purchases the implants at-cost from the manufacturer? QID: 211122 FIGURES: A B Type & Select Correct Answer 1 Long cephalomedullary nail 2% (27/1740) 2 Short cephelomedullary nail 8% (146/1740) 3 Sliding hip screw 77% (1337/1740) 4 Hemiarthroplasty 1% (23/1740) 5 Cannulated screws 11% (186/1740) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ18.206) An 87-year-old female sustained the injury shown in Figure A. Which of the following is/are factor(s) that increase the risk of perforation of the anterior cortex during surgical treatment with a long cephalomedullary nail? QID: 213102 FIGURES: A Type & Select Correct Answer 1 Radius of curvature mismatch between the bone and the implant 2% (44/2188) 2 Anterior starting point on the greater trochanter 1% (31/2188) 3 Posterior starting point on the greater trochanter 3% (62/2188) 4 Answers 1 and 2 17% (380/2188) 5 Answers 1 and 3 75% (1647/2188) L 4 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ18.240) A 78-year-old patient presents with right hip pain and inability to bear weight after an unwitnessed fall at a nursing home. Figures A and B are the radiographs of the hip and pelvis. Which statement is true regarding the treatment of these injuries? QID: 213136 FIGURES: A B Type & Select Correct Answer 1 Smaller lateral wall thickness favors sliding hip screw constructs 2% (39/2418) 2 Unstable fractures are best treated with sliding hip screw constructs 2% (39/2418) 3 Avoiding distal locking screws in intramedullary implants protects against refracture 1% (33/2418) 4 Stable fractures have no differences in outcomes between sliding hip screws and intramedullary implants 89% (2146/2418) 5 Implant stability has a greater impact on outcomes rather than reduction quality 3% (79/2418) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ18.239) An 82-year-old female sustains the fracture shown in Figure A as the result of a ground level fall. Which of the following has been shown to be a reliable predictor of postoperative lateral wall fracture for this injury after treatment with a sliding hip screw? QID: 213135 FIGURES: A Type & Select Correct Answer 1 Reverse obliquity fracture pattern 18% (388/2169) 2 Lateral wall thickness 64% (1380/2169) 3 Previous contralateral hip fracture 1% (29/2169) 4 DEXA T-score <-2.0 5% (114/2169) 5 Calcar comminution 11% (238/2169) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.2) A 86-year-old man slips on the ice and falls sustaining the injury shown in Figure A. He has Type 2 diabetes mellitus, atrial fibrillation, coronary artery disease, end-stage renal disease on dialysis and chronic obstructive lung disease. All of the following variables are associated with increased mortality at one year after injury EXCEPT? QID: 4637 FIGURES: A Type & Select Correct Answer 1 Intertrochanteric fracture 5% (207/4591) 2 Two or more pre-existing medical conditions 1% (63/4591) 3 Age of eighty-five years or more 2% (78/4591) 4 Male gender 10% (458/4591) 5 Operative fixation within 48 hours 82% (3767/4591) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ11.172) Which of the following methods accurately describes the measurement of tip-apex-distance as it relates to placement of a lag screw in the femoral head? QID: 3595 Type & Select Correct Answer 1 Summation of the distance between the end of the screw and the apex of the femoral head on AP and lateral radiographs 94% (3497/3706) 2 Distance from the acetabular teardrop to the tip of the screw on an AP radiograph of the hip 2% (58/3706) 3 Multiplication of the distance between the end of the screw and the apex of the femoral head on AP and lateral radiographs 1% (51/3706) 4 Distance from the center of the lesser trochanter to the tip of the screw on an AP hip radiograph 1% (35/3706) 5 Summation of the distance between the tip of the greater trochanter and end of the screw on AP and lateral hip radiographs 1% (45/3706) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ11.189) Which of the following deformities is most likely to occur with dynamic hip screw fixation of unstable left sided standard obliquity hip fractures? QID: 3612 Type & Select Correct Answer 1 Posterior spike displacement of the proximal fragment 8% (174/2292) 2 Anterior spike displacement of the proximal fragment 62% (1417/2292) 3 Lateral displacement of the proximal fragment relative to the distal fragment 11% (258/2292) 4 Shortening of the proximal fragment relative to the distal fragment 5% (104/2292) 5 Medial displacement of the proximal fragment in relation to the distal fragment 14% (326/2292) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ10.17) A 74-year-old female falls from a standing height and sustains the fracture shown in Figure A. The occurrence of this injury most increases her risk of subsequently sustaining which of the following fractures in the future? QID: 3105 FIGURES: A Type & Select Correct Answer 1 Sacral fracture 2% (41/2065) 2 Hip fracture 65% (1336/2065) 3 Distal radius fracture 17% (344/2065) 4 Distal fibula fracture 1% (11/2065) 5 Distal humerus fracture 16% (328/2065) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (SBQ09TR.45.1) Which of the following is an advantage of sliding hip screws compared to cephalomedullary nails for the treatment of appropriate intertrochanteric femur fractures? QID: 211031 Type & Select Correct Answer 1 Decreased risk of deep venous thrombosis 1% (21/2572) 2 Biomechanically advantageous under physiologic loading 14% (368/2572) 3 Decreased blood loss 10% (264/2572) 4 Decreased risk of nonunion 2% (60/2572) 5 None of the above 72% (1845/2572) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ09.233) Which of the following statements is true regarding treatment of intertrochanteric hip fractures with an intramedullary nail versus a sliding hip screw? QID: 3046 Type & Select Correct Answer 1 The use of intramedullary nail has increased in the last ten years 84% (821/979) 2 The use of sliding hip screws has increased in the last ten years 4% (39/979) 3 Medicare reimbursement is more for a sliding hip screw 1% (14/979) 4 Intramedullary nails have demonstrated superior outcomes in randomized-controlled studies 8% (77/979) 5 Sliding hip screw is superior for treatment of reverse obliquity intertrochanteric fractures 3% (25/979) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ09.222) A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. This patient is at increased risk of what complication? QID: 3035 Type & Select Correct Answer 1 lag screw cutout 96% (1576/1640) 2 osteonecrosis 1% (13/1640) 3 osteoarthritis 1% (14/1640) 4 peri-prosthetic fracture 1% (15/1640) 5 lag screw breakage 1% (18/1640) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ09.3) Which of the following factors has been shown to be the strongest predictor of screw cutout of a dynamic compression hip screw used for an intertrochanteric femur fracture? QID: 2816 Type & Select Correct Answer 1 Age of the patient 1% (28/3257) 2 Intrinsic stability of the fracture 4% (143/3257) 3 Tip-apex distance 92% (2984/3257) 4 Quality of reduction 2% (80/3257) 5 Angle of the sideplate 0% (14/3257) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ08.138) An 82-year-old female sustains an intertrochanteric hip fracture and is treated with a sliding hip screw. What is the most appropriate definitive step in treating the failure seen in figure A? QID: 524 FIGURES: A Type & Select Correct Answer 1 Non-weight bearing 0% (4/832) 2 Valgus proximal femoral osteotomy 6% (53/832) 3 Total hip arthroplasty 82% (680/832) 4 Revision open reduction and internal fixation 10% (85/832) 5 Proximal femoral resection 1% (7/832) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ07.246) A 72-year-old male sustains the injury shown in Figure A as a result of a fall from a ladder. Which of the following factors has been shown to be associated with increased collapse or sliding displacement? QID: 907 FIGURES: A Type & Select Correct Answer 1 Use of a long intramedullary device 1% (8/1016) 2 Use of a short intramedullary device 6% (61/1016) 3 Use of external fixation 2% (25/1016) 4 Postoperative weight bearing status 6% (63/1016) 5 Intraoperative fracture of the lateral femoral wall 84% (857/1016) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ07.153) Anterior perforation of the distal femur from antegrade femoral nailing has been attributed to what factor? QID: 814 Type & Select Correct Answer 1 Non-anatomic reduction 2% (63/2978) 2 Mismatch of the radius of curvature of implant and bone 91% (2717/2978) 3 Usage of too large an implant 2% (58/2978) 4 Lateral patient positioning 1% (19/2978) 5 Lateral proximal starting point 4% (111/2978) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ07.86) Which of the following is not an appropriate implant for treatment of the fracture seen in Figure A? QID: 747 FIGURES: A Type & Select Correct Answer 1 Cephalomedullary nail 7% (186/2573) 2 External fixation 8% (204/2573) 3 Proximal femoral locking plate 2% (64/2573) 4 95 degree blade plate 2% (40/2573) 5 Sliding hip screw 81% (2073/2573) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ06.157) Which of the following is a recognized predictor of mortality after hip fracture? QID: 343 Type & Select Correct Answer 1 American Society of Anesthesiologist (ASA) classification 73% (1031/1416) 2 Post-operative weight bearing status 23% (328/1416) 3 Fracture comminution 2% (35/1416) 4 Fixation device used 0% (6/1416) 5 Type of anesthetic used 1% (13/1416) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ05.262) When treating a stable 2-part intertrochanteric hip fracture with a sliding hip screw construct, what is the minimum number of screw holes that are needed in the side plate for successful fixation? QID: 1148 Type & Select Correct Answer 1 One 3% (29/1056) 2 Two 80% (841/1056) 3 Three 13% (141/1056) 4 Four 4% (38/1056) 5 Five 0% (1/1056) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ05.210) All of the following implants offer adequate fracture fixation of the injury shown in Figure A EXCEPT: QID: 1096 FIGURES: A Type & Select Correct Answer 1 Trochanteric entry point cephalomedullary nail 3% (73/2535) 2 Piriformis fossa entry point cephalomedullary nail 3% (70/2535) 3 Dynamic hip screw 84% (2138/2535) 4 Fixed angle blade plate 2% (56/2535) 5 95 degree dynamic condylar screw 8% (191/2535) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ05.161) A 55-year-old male is involved in a motor vehicle accident and sustains the injury seen in Figure A. What is the most appropriate treatment for this type of injury? QID: 1047 FIGURES: A Type & Select Correct Answer 1 Total hip arthroplasty 1% (12/1612) 2 Bipolar hemi-arthroplasty 1% (10/1612) 3 Sliding hip screw 3% (47/1612) 4 Percutaneous screw fixation 0% (8/1612) 5 Cephalomedullary nail fixation 95% (1529/1612) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic
All Videos (11) Podcasts (2) Login to View Community Videos Login to View Community Videos 2018 Orthopaedic Summit Evolving Techniques 77-Year-Old Status Post Intermedullary Nail For An IT Hip Fracture, Now Needing A Total Hip Replacement - Oh The Problems, Are They Real, Should The Patient Have Had A Sliding Hip Screw - Simon C. Mears, MD, PhD, FAOA (OSET 2018) Simon Mears Trauma - Intertrochanteric Fractures D 8/12/2019 479 views 3.0 (1) Login to View Community Videos Login to View Community Videos 2018 Orthopaedic Summit Evolving Techniques Pro: Read The Literature: The IM Nail, It Is The Right Answer - Get Them Up Out Of Bed Today - David B. Weiss, MD (OSET 2018) David B. Weiss Trauma - Intertrochanteric Fractures A 8/12/2019 931 views 3.8 (4) Login to View Community Videos Login to View Community Videos 2018 Orthopaedic Summit Evolving Techniques Pro: Wake Up! It Is The Blade Plate, You Just Don’t Know How To Do It! The Lost Art With Better Success - Michael J. Gardner, MD (OSET 2018) Team Orthobullets (5) Trauma - Intertrochanteric Fractures A 8/12/2019 880 views 5.0 (4) Trauma | Intertrochanteric Fractures Trauma - Intertrochanteric Fractures Listen Now 20:12 min 10/19/2019 1707 plays 4.9 (15) Question Session | Intertrochanteric Fractures & Legg-Calve-Perthes Disease Orthobullets Team Trauma - Intertrochanteric Fractures Listen Now 17:50 min 11/11/2019 170 plays 5.0 (2) See More See Less
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