ASBMR Task Force Case Definition of Atypical Femur Fractures (AFFs), Revised criteriaFour of five major features should be present to designate a fracture as atypical; minor features may or may not be present in individual cases
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An 80-year-old patient presents 8 months postoperatively with right groin pain. Examination reveals a leg length discrepancy of 1.5cm. Recent radiographs are seen in Figures A and B. What is the most appropriate treatment plan?
Hardware removal, correction of alignment with a Taylor spatial frame, insertion of bone autograft
Exchange unreamed nailing with a longer, larger implant
Augmentative plate fixation without nail removal, insertion of bone autograft
Hardware removal, correction of alignment, plate fixation, insertion of bone autograft
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A 76-year-old female with underlying osteoporosis presents with severe right leg pain after stepping off a curb. Current femur radiographs are shown in Figure A. Review of the patient's medical records reveal that she had been evaluated 3 months prior for right hip pain, and work-up at that time was negative. Radiographs of the patient's femur from that previous visit are shown in Figure B. What is the most likely cause of this patient's femur fracture?
Fibrous cortical defect
Which of the following fractures seen in Figures A through E would be amenable to fixation with a construct using tension band principles?
A 65-year-old male presents with continued left hip and thigh pain, and inability to bear full weight after undergoing ORIF of a left proximal femur fracture 3 months ago. Current radiographs are shown in Figure A. The patient denies any fevers, or other systemic signs of illness. Which of the following would have potentially decreased the risk of excess fracture collapse and implant failure in this patient?
Use of a six-hole 135 degree compression plate
Addition of iliac crest autograft to the fracture site
Application of long strut allografts around the fracture site
Placement of a cephalomedullary nail
Addition of an 7.3mm de-rotation screw in the femoral head
A 66-year-old male with a remote history of prostate cancer sustains a fall down a hill while gardening. During intramedullary nailing of his fracture, which intraoperative reduction maneuvers should take place to the proximal fragment to properly align the fracture?
Flexion and internal rotation
Extension and internal rotation
Flexion and external rotation
Extension and external rotation
Abduction and internal rotation
An 80-year-old female falls and sustains the fracture seen in Figure A. She is treated with an antegrade cephalomedullary nail. Which of the following led to the complication seen in Figure B?
Nail with a lesser radius of curvature
Nail with a greater radius of curvature
Piriformis entry portal
Trochanteric entry portal
Lateral decubitus patient position
A 35-year-old-male sustains the fracture seen in Figure A. Which of the following reduction forces must be applied to the proximal fragment to correct the deformity commonly seen in these fractures?
Adduction and extension
Abduction and extension
Adduction and flexion
Abduction and flexion
All of the following are advantages of supine over lateral positioning during intramedullary nailing of subtrochanteric femur fractures EXCEPT:
Can be protective to an injured spine
Facilitates access to other injured sites in the polytrauma patient
Provides easier fluoroscopic imaging
Allows for easy reduction of the distal fragment to the flexed proximal fragment
Easier to assess rotation
Which muscles cause the fracture displacement of the proximal fragment shown in figure A?
gluteus maximus and adductors
gluteus maximus and rectus femoris
gluteus medius and hamstrings
gluteus medius and iliopsoas
rectus femoris and hamstrings
What muscles are responsible for the most common deformity after antegrade intramedullary nailing for a subtrochanteric femur fracture?
Hip abductors and iliopsoas muscle
Hip internal rotators and iliopsoas muscle
Quadriceps and iliopsoas muscle
Hamstring and iliopsoas muscle
Quadriceps and hip adductors