Femur fractures OSET Simon C. Mears, MD, PhD University of - PowerPoint PPT Presentation

Femur fractures OSET Simon C. Mears, MD, PhD University of Arkansas for Medical Sciences

21yoF CC: R leg pain HPI: received hoverboard for Christmas present. Upon first use fell onto right side, could not walk, obvious deformity, otherwise healthy woman Exam: leg with gross thigh deformity, no open wounds, NVI distally

Presentation xray

Treatment options • Low energy trauma • Resuscitated • Intramedullary fixation – Antegrade vs retrograde? – Nail entry? – Positioning?

Antegrade trochanteric entry nail on fracture table Narrow femoral canal 9mm nail No obvious femoral neck fracture Lachman test negative Rotation even

3 month followup Doing well, Clinically and radiographically healed

25 year old man CC: gunshot to right femur HPI: low caliber gun, isolated injury to right thigh PMHx: none Exam: alert, +dp/pt pulses, strong foot motion and intact sensation. Unable to move leg

Injury films

Treatment options Retrograde nail Plate fixation

Distal femoral locking plate Indirect reduction

3 month followup Allowed immediate weight bearing and range of motion

Failed hip fracture • 80 yo woman with previous hip fracture 11 months ago. Has had problems ever since surgery. Formally very active real estate agent. Since then limited walking • Now with 1 week of severe pain in groin and inability to ambulate • PMH/PSH: previous stroke, vertigo, fibromyalgia, takes Plavix and aspirin • Exam: Leg is shortened and rotated, very painful to motion, unable to weight bear

Presentation xrays

Options • Workup? • Type of stem? • What about the cup? • Problems with conversion from IM nail? • Stability?

Postop: Hybrid total hip replacement

Postop course • Cultures negative at day 5 • Mobilized, WBAT • Dc to rehab center POD 3 • Doing very well at 3 months, walking with cane, getting back to selling houses

LM is a 73 y.o. year old female patient who was transferred from OSH after falling in her kitchen and c/o knee pain She reports she has had both knees and both hips replaced. Fall Thursday Transferred at 1 am Saturday

Medical history • HTN • CAD w/ stent placement 15 years ago • Pacemaker (placed in 2007, last checked in 08/2015) • GERD • Carotid artery disease s/p CEA 2003 • Chronic back pain due to spinal stenosis which she has taken daily Percocet for the last 5 years.

Options?? • ORIF • Revision TKA • What to do about Hip replacement above?? • Medicine : Cardiovascular - normal exam , Exercise tolerance: 4 METS or > • Maximized for surgery

Postop • Mobilized WBAT • POD 3 dc’ed to sisters house (No SNF) • Seen at 6 weeks: 0-120 motion, walking well