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Forum: OWL Lists: OTA:
[ORT-L] R HIP / FEMUR FX + L FEMUR FX

 
 


john_schlechter at yahoo
New User

Feb 1, 2007, 5:36 AM

Post #1 of 10 (6462 views)
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[ORT-L] R HIP / FEMUR FX + L FEMUR FX Can't Post
I was hoping to get some input on a few questions regarding the following case.

33 yo male motocross rider crashed after a jump sustaining isolated bilateral femur fxs, R side with a basicervical femoral neck and ipsilateral mid-distal 1/3 shaft, L side with a subtroch/prox 1/3 femur fx. Pt was HD stable, no LOC, GCS - 15, No other injuries, spines cleared.

Questions about this case:

Timing and sequence of surgery ( which fx to fix first)
Pt positioning
Implant(s)

Thank you in advance for any feedback.

John Schlechter, DO
Resident Orthopaedic Surgery
Riverside County Medical Center
Moreno Valley, CA







____________________________________________________________________________________
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Attachments: bl femur.ppt (377 KB)


jeffrichmondmd at hotmail
New User

Feb 1, 2007, 6:21 AM

Post #2 of 10 (6462 views)
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RE: [ORT-L] R HIP / FEMUR FX + L FEMUR FX [In reply to] Can't Post
The most critical injury is the proximal fracture on the right.

Supine position on a radiolucent table.

Temporary (k-wire/guidewire) fixation in the neck if it can be anatomically
reduced closed, open if necessary.

Retrograde nail right femur being careful that you don't knock off the neck
fx.

DHS with de-rotation screw for neck (make sure you carefully tap the screw
path so as not to spin off the reduction when the screw purchases, possible
even with a derotation screw) and use a plate that overlaps your nail (can
put plate screws around nail, or through a locking hole). Alternatively, the
synthes locking proximal femoral plate could be used.

Left side- same table/postion, antegrade nail

Jeff Richmond
North Shore University Hospital
Manhasset, NY



>From: john schlechter <john_schlechter@yahoo.com>
>Reply-To: ORT-L@www2.aaos.org
>To: ORT-L@www2.aaos.org
>Subject: [ORT-L] R HIP / FEMUR FX + L FEMUR FX
>Date: Thu, 1 Feb 2007 05:36:23 -0800 (PST)
>
>I was hoping to get some input on a few questions regarding the following
>case.
>
>33 yo male motocross rider crashed after a jump sustaining isolated
>bilateral femur fxs, R side with a basicervical femoral neck and
>ipsilateral mid-distal 1/3 shaft, L side with a subtroch/prox 1/3 femur fx.
>Pt was HD stable, no LOC, GCS - 15, No other injuries, spines cleared.
>
>Questions about this case:
>
>Timing and sequence of surgery ( which fx to fix first)
>Pt positioning
>Implant(s)
>
>Thank you in advance for any feedback.
>
>John Schlechter, DO
>Resident Orthopaedic Surgery
>Riverside County Medical Center
>Moreno Valley, CA
>
>
>
>
>
>
>
>____________________________________________________________________________________
>TV dinner still cooling?
>Check out "Tonight's Picks" on Yahoo! TV.
>http://tv.yahoo.com/


><< blfemur.ppt >>


---
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mlroutt at u
New User

Feb 1, 2007, 6:26 AM

Post #3 of 10 (6462 views)
Shortcut
Re: [ORT-L] R HIP / FEMUR FX + L FEMUR FX [In reply to] Can't Post
Timing- now for the right, and now for the left if he remains well after the
right is completed.

Sequence ­ Right neck, right shaft, then left shaft.

2 positions ­ 2 drapes/preps, rolled oblique for both.

Implants ­ plenty of opinions exist for the right side...some would use neck
screws anteriorly after reduction, then with a slender reamed locked nail
pushed in behind the neck screws for the shaft...some will advocate a recon
nail for both...some will use a sliding screw for the neck then a retrograde
shaft nail...some would use the sliding neck screw and a shaft plate
also...lots of options.

I prefer excellent neck reduction either closed or open, screws high and low
anteriorly for it, then a frail locked nail slipped in behind the neck
screws for the shaft.

Some will also advocate hip capsulotomy as well to relieve capsular pressure
related issues...it¹s done when you choose ORIF of the neck.

The left shaft fracture should accommodate an antegrade reamed locked nail
after reduction, unless I¹ve missed some detail on the films as shown.

I¹d use 2 preps and drapes and assure that he¹s well after the right side
before rolling on to the left.

Easy on the reaming-

Chip








> I was hoping to get some input on a few questions regarding the following
> case.
>
> 33 yo male motocross rider crashed after a jump sustaining isolated bilateral
> femur fxs, R side with a basicervical femoral neck and ipsilateral mid-distal
> 1/3 shaft, L side with a subtroch/prox 1/3 femur fx. Pt was HD stable, no LOC,
> GCS - 15, No other injuries, spines cleared.
>
> Questions about this case:
>
> Timing and sequence of surgery ( which fx to fix first)
> Pt positioning
> Implant(s)
>
> Thank you in advance for any feedback.
>
> John Schlechter, DO
> Resident Orthopaedic Surgery
> Riverside County Medical Center
> Moreno Valley, CA
>
>
>
>
> Finding fabulous fares is fun.
> Let Yahoo! FareChase search your favorite travel sites
> <http://farechase.yahoo.com/promo-generic-14795097;_ylc=X3oDMTFtNW45amVpBF9TAz
> k3NDA3NTg5BF9zAzI3MTk0ODEEcG9zAzEEc2VjA21haWx0YWdsaW5lBHNsawNxMS0wNw--> to
> find flight and hotel bargains.


M.L. Chip Routt, Jr.,M.D.
Professor-Orthopedic Surgery
Harborview Medical Center
325 Ninth Avenue
Box 359798
Seattle, WA 98104-2499
phone 206-731-3658
FAX 206-731-3227
--




dpzamorano at hotmail
New User

Feb 1, 2007, 9:12 AM

Post #4 of 10 (6462 views)
Shortcut
RE: [ORT-L] R HIP / FEMUR FX + L FEMUR FX [In reply to] Can't Post
basicervical neck is normally treated with hip screw or cephalomedullary nail.
i would use fx table with 2 preps/drapes
after perfect reduction (either closed or open) i would attempt 1 implant to treat both (i.e. TFN or Intertan). can do anything though like Dr. Routt mentioned. intertan is nice because of the rotational stability it imparts in the neck
i would use an antegrade nail on the left

dpz





David P. Zamorano, MD
Assistant Chief, Orthopaedic Trauma Service
Dept. of Orthopaedic Surgery
Harbor/UCLA Medical Center
Office (310) 222-2716
Fax (310) 533-8791
dpzamorano@hotmail.com
From: john schlechter <john_schlechter@yahoo.com>
Reply-To: ORT-L@www2.aaos.org
To: ORT-L@www2.aaos.org
Subject: [ORT-L] R HIP / FEMUR FX + L FEMUR FX
Date: Thu, 1 Feb 2007 05:36:23 -0800 (PST)

I was hoping to get some input on a few questions regarding the following case.

33 yo male motocross rider crashed after a jump sustaining isolated bilateral femur fxs, R side with a basicervical femoral neck and ipsilateral mid-distal 1/3 shaft, L side with a subtroch/prox 1/3 femur fx. Pt was HD stable, no LOC, GCS - 15, No other injuries, spines cleared.

Questions about this case:

Timing and sequence of surgery ( which fx to fix first)
Pt positioning
Implant(s)

Thank you in advance for any feedback.

John Schlechter, DO
Resident Orthopaedic Surgery
Riverside County Medical Center
Moreno Valley, CA



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Let Yahoo! FareChase search your favorite travel sites to find flight and hotel bargains.

><< blfemur.ppt >>

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alex61 at gmail
New User

Feb 1, 2007, 9:51 AM

Post #5 of 10 (6462 views)
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Re: [ORT-L] R HIP / FEMUR FX + L FEMUR FX [In reply to] Can't Post
Dear John

john wrote 1 ??????? 2007 ?., 18:36:23:

> Timing and sequence of surgery ( which fx to fix first)

I would go to the simple side (left) first because if start with more
difficult side and something goes wrong one can get stuck. And it is
nice to know that when all problems still are sorted out you will have
nothing more to do with the patient.

> Pt positioning

Supine - any other options?

> Implant(s)

Chip Routt listed all main options. The right proximal fracture
looks closer to trochanteric. Most elegant solution would be to fix
all with a single implant with minimal incisions. Long Gamma nail or
any other reconstruction or proximal type nails are suitable.
Technically less demanding wiuld be temporary neck pinning as is,
retrograde nailing of the shaft, then final reduction and fixation of
the trochanteric fracture as isolated, by DHS with 2 holes plate.
Good luck.

--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia

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john_schlechter at yahoo
New User

Feb 1, 2007, 11:25 AM

Post #6 of 10 (6462 views)
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Re: [ORT-L] R HIP / FEMUR FX + L FEMUR FX [In reply to] Can't Post
Dr. Routt,

Thank you for your reply. This maybe a stupid question. I am assuming that a "frail nail" is a smaller diameter nail?

JS


----- Original Message ----
From: Chip Routt <mlroutt@u.washington.edu>
To: ORT-L@www2.aaos.org
Sent: Thursday, February 1, 2007 6:26:33 AM
Subject: Re: [ORT-L] R HIP / FEMUR FX + L FEMUR FX

Timing- now for the right, and now for the left if he remains well after the right is completed.

Sequence – Right neck, right shaft, then left shaft.

2 positions – 2 drapes/preps, rolled oblique for both.

Implants – plenty of opinions exist for the right side...some would use neck screws anteriorly after reduction, then with a slender reamed locked nail pushed in behind the neck screws for the shaft...some will advocate a recon nail for both...some will use a sliding screw for the neck then a retrograde shaft nail...some would use the sliding neck screw and a shaft plate also...lots of options.

I prefer excellent neck reduction either closed or open, screws high and low anteriorly for it, then a frail locked nail slipped in behind the neck screws for the shaft.

Some will also advocate hip capsulotomy as well to relieve capsular pressure related issues...it’s done when you choose ORIF of the neck.

The left shaft fracture should accommodate an antegrade reamed locked nail after reduction, unless I’ve missed some detail on the films as shown.

I’d use 2 preps and drapes and assure that he’s well after the right side before rolling on to the left.

Easy on the reaming-

Chip









I was hoping to get some input on a few questions regarding the following case.

33 yo male motocross rider crashed after a jump sustaining isolated bilateral femur fxs, R side with a basicervical femoral neck and ipsilateral mid-distal 1/3 shaft, L side with a subtroch/prox 1/3 femur fx. Pt was HD stable, no LOC, GCS - 15, No other injuries, spines cleared.

Questions about this case:

Timing and sequence of surgery ( which fx to fix first)
Pt positioning
Implant(s)

Thank you in advance for any feedback.

John Schlechter, DO
Resident Orthopaedic Surgery
Riverside County Medical Center
Moreno Valley, CA





Finding fabulous fares is fun.
Let Yahoo! FareChase search your favorite travel sites <http://farechase.yahoo.com/promo-generic-14795097;_ylc=X3oDMTFtNW45amVpBF9TAzk3NDA3NTg5BF9zAzI3MTk0ODEEcG9zAzEEc2VjA21haWx0YWdsaW5lBHNsawNxMS0wNw--> to find flight and hotel bargains.



M.L. Chip Routt, Jr.,M.D.
Professor-Orthopedic Surgery
Harborview Medical Center
325 Ninth Avenue
Box 359798
Seattle, WA 98104-2499
phone 206-731-3658
FAX 206-731-3227
--



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mlroutt at u
New User

Feb 1, 2007, 4:22 PM

Post #7 of 10 (6462 views)
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Re: [ORT-L] R HIP / FEMUR FX + L FEMUR FX [In reply to] Can't Post
Yes...sorry to be unclear...a smaller diameter (10 or 11mm) and a thin
walled routine nail (eg. Synthes Universal Femoral) would be my goal.

Chip






> Dr. Routt,
>
> Thank you for your reply. This maybe a stupid question. I am assuming that a
> "frail nail" is a smaller diameter nail?
>
> JS
>
> ----- Original Message ----
> From: Chip Routt <mlroutt@u.washington.edu>
> To: ORT-L@www2.aaos.org
> Sent: Thursday, February 1, 2007 6:26:33 AM
> Subject: Re: [ORT-L] R HIP / FEMUR FX + L FEMUR FX
>
> Timing- now for the right, and now for the left if he remains well after the
> right is completed.
>
> Sequence ­ Right neck, right shaft, then left shaft.
>
> 2 positions ­ 2 drapes/preps, rolled oblique for both.
>
> Implants ­ plenty of opinions exist for the right side...some would use neck
> screws anteriorly after reduction, then with a slender reamed locked nail
> pushed in behind the neck screws for the shaft...some will advocate a recon
> nail for both...some will use a sliding screw for the neck then a retrograde
> shaft nail...some would use the sliding neck screw and a shaft plate
> also...lots of options.
>
> I prefer excellent neck reduction either closed or open, screws high and low
> anteriorly for it, then a frail locked nail slipped in behind the neck screws
> for the shaft.
>
> Some will also advocate hip capsulotomy as well to relieve capsular pressure
> related issues...it¹s done when you choose ORIF of the neck.
>
> The left shaft fracture should accommodate an antegrade reamed locked nail
> after reduction, unless I¹ve missed some detail on the films as shown.
>
> I¹d use 2 preps and drapes and assure that he¹s well after the right side
> before rolling on to the left.
>
> Easy on the reaming-
>
> Chip
>
>
>
>
>
>
>
>
>> I was hoping to get some input on a few questions regarding the following
>> case.
>>
>> 33 yo male motocross rider crashed after a jump sustaining isolated bilateral
>> femur fxs, R side with a basicervical femoral neck and ipsilateral mid-distal
>> 1/3 shaft, L side with a subtroch/prox 1/3 femur fx. Pt was HD stable, no
>> LOC, GCS - 15, No other injuries, spines cleared.
>>
>> Questions about this case:
>>
>> Timing and sequence of surgery ( which fx to fix first)
>> Pt positioning
>> Implant(s)
>>
>> Thank you in advance for any feedback.
>>
>> John Schlechter, DO
>> Resident Orthopaedic Surgery
>> Riverside County Medical Center
>> Moreno Valley, CA
>>
>>
>>
>>
>> Finding fabulous fares is fun.
>> Let Yahoo! FareChase search your favorite travel sites
>> <http://farechase.yahoo.com/promo-generic-14795097;_ylc=X3oDMTFtNW45amVpBF9TA
>> zk3NDA3NTg5BF9zAzI3MTk0ODEEcG9zAzEEc2VjA21haWx0YWdsaW5lBHNsawNxMS0wNw--> to
>> find flight and hotel bargains.
>
>
> M.L. Chip Routt, Jr.,M.D.
> Professor-Orthopedic Surgery
> Harborview Medical Center
> 325 Ninth Avenue
> Box 359798
> Seattle, WA 98104-2499
> phone 206-731-3658
> FAX 206-731-3227


M.L. Chip Routt, Jr.,M.D.
Professor-Orthopedic Surgery
Harborview Medical Center
325 Ninth Avenue
Box 359798
Seattle, WA 98104-2499
phone 206-731-3658
FAX 206-731-3227
--




jjbrooksmd at gmail
New User

Feb 7, 2007, 3:55 AM

Post #8 of 10 (6462 views)
Shortcut
Re: [ORT-L] R HIP / FEMUR FX + L FEMUR FX [In reply to] Can't Post
Dear John,

What did you do with this difficult case?

Jeff


On Feb 1, 2007, at 2:25 PM, john schlechter wrote:

> Dr. Routt,
>
> Thank you for your reply. This maybe a stupid question. I am
> assuming that a "frail nail" is a smaller diameter nail?
>
> JS
>
> ----- Original Message ----
> From: Chip Routt <mlroutt@u.washington.edu>
> To: ORT-L@www2.aaos.org
> Sent: Thursday, February 1, 2007 6:26:33 AM
> Subject: Re: [ORT-L] R HIP / FEMUR FX + L FEMUR FX
>
> Timing- now for the right, and now for the left if he remains well
> after the right is completed.
>
> Sequence – Right neck, right shaft, then left shaft.
>
> 2 positions – 2 drapes/preps, rolled oblique for both.
>
> Implants – plenty of opinions exist for the right side...some would
> use neck screws anteriorly after reduction, then with a slender
> reamed locked nail pushed in behind the neck screws for the
> shaft...some will advocate a recon nail for both...some will use a
> sliding screw for the neck then a retrograde shaft nail...some
> would use the sliding neck screw and a shaft plate also...lots of
> options.
>
> I prefer excellent neck reduction either closed or open, screws
> high and low anteriorly for it, then a frail locked nail slipped in
> behind the neck screws for the shaft.
>
> Some will also advocate hip capsulotomy as well to relieve capsular
> pressure related issues...it’s done when you choose ORIF of the neck.
>
> The left shaft fracture should accommodate an antegrade reamed
> locked nail after reduction, unless I’ve missed some detail on the
> films as shown.
>
> I’d use 2 preps and drapes and assure that he’s well after the
> right side before rolling on to the left.
>
> Easy on the reaming-
>
> Chip
>
>
>
>
>
>
>
>
> I was hoping to get some input on a few questions regarding the
> following case.
>
> 33 yo male motocross rider crashed after a jump sustaining isolated
> bilateral femur fxs, R side with a basicervical femoral neck and
> ipsilateral mid-distal 1/3 shaft, L side with a subtroch/prox 1/3
> femur fx. Pt was HD stable, no LOC, GCS - 15, No other injuries,
> spines cleared.
>
> Questions about this case:
>
> Timing and sequence of surgery ( which fx to fix first)
> Pt positioning
> Implant(s)
>
> Thank you in advance for any feedback.
>
> John Schlechter, DO
> Resident Orthopaedic Surgery
> Riverside County Medical Center
> Moreno Valley, CA
>
>
>
> Finding fabulous fares is fun.
> Let Yahoo! FareChase search your favorite travel sites <http://
> farechase.yahoo.com/promo-
> generic-14795097;_ylc=X3oDMTFtNW45amVpBF9TAzk3NDA3NTg5BF9zAzI3MTk0ODEE
> cG9zAzEEc2VjA21haWx0YWdsaW5lBHNsawNxMS0wNw--> to find flight and
> hotel bargains.
>
>
> M.L. Chip Routt, Jr.,M.D.
> Professor-Orthopedic Surgery
> Harborview Medical Center
> 325 Ninth Avenue
> Box 359798
> Seattle, WA 98104-2499
> phone 206-731-3658
> FAX 206-731-3227
> --
>
>
>
> Looking for earth-friendly autos?
> Browse Top Cars by "Green Rating" at Yahoo! Autos' Green Center.

Jeffrey J Brooks, MD
Hand & Upper Extremity Surgery
Orthopaedic Trauma Surgery

Orthopaedic Surgery & Sports medicine center
1290 Summer Street, #4400
Stamford, CT 06905
(203) 323-7331


The information contained in this electronic mail transmittal may
contain healthcare information and is protected by law. This message
is intended only for the use of the designated recipient(s) named
above. If the reader of this transmission is not the intended
recipient(s), you are notified that any disclosure, dissemination,
distribution or duplication of its contents is strictly prohibited.
If you have received this transmittal in error, please notify the
sender by return e-mail and delete the transmittal immediately. Thank
you.






john_schlechter at yahoo
New User

Feb 7, 2007, 5:20 AM

Post #9 of 10 (6462 views)
Shortcut
Re: [ORT-L] R HIP / FEMUR FX + L FEMUR FX [In reply to] Can't Post
Jeff,
Supine - radiolucent table, Femoral neck was provisionally stabilized after reduction with two pins one for the DHS screw and the second as a derotational pin, DHS was placed, followed by retro IMR , second prep and drape and then the left femur was fixed with a cephalomedullary nail on the fracture table, hemilithotomy position.

----- Original Message ----
From: Jeff Brooks <jjbrooksmd@gmail.com>
To: ORT-L@www2.aaos.org
Sent: Wednesday, February 7, 2007 3:55:02 AM
Subject: Re: [ORT-L] R HIP / FEMUR FX + L FEMUR FX

Dear John,

What did you do with this difficult case?


Jeff



On Feb 1, 2007, at 2:25 PM, john schlechter wrote:

Dr. Routt,

Thank you for your reply. This maybe a stupid question. I am assuming that a "frail nail" is a smaller diameter nail?

JS


----- Original Message ----
From: Chip Routt <mlroutt@u.washington.edu>
To: ORT-L@www2.aaos.org
Sent: Thursday, February 1, 2007 6:26:33 AM
Subject: Re: [ORT-L] R HIP / FEMUR FX + L FEMUR FX

Timing- now for the right, and now for the left if he remains well after the right is completed.

Sequence – Right neck, right shaft, then left shaft.

2 positions – 2 drapes/preps, rolled oblique for both.

Implants – plenty of opinions exist for the right side...some would use neck screws anteriorly after reduction, then with a slender reamed locked nail pushed in behind the neck screws for the shaft...some will advocate a recon nail for both...some will use a sliding screw for the neck then a retrograde shaft nail...some would use the sliding neck screw and a shaft plate also...lots of options.

I prefer excellent neck reduction either closed or open, screws high and low anteriorly for it, then a frail locked nail slipped in behind the neck screws for the shaft.

Some will also advocate hip capsulotomy as well to relieve capsular pressure related issues...it’s done when you choose ORIF of the neck.

The left shaft fracture should accommodate an antegrade reamed locked nail after reduction, unless I’ve missed some detail on the films as shown.

I’d use 2 preps and drapes and assure that he’s well after the right side before rolling on to the left.

Easy on the reaming-

Chip








I was hoping to get some input on a few questions regarding the following case.

33 yo male motocross rider crashed after a jump sustaining isolated bilateral femur fxs, R side with a basicervical femoral neck and ipsilateral mid-distal 1/3 shaft, L side with a subtroch/prox 1/3 femur fx. Pt was HD stable, no LOC, GCS - 15, No other injuries, spines cleared.

Questions about this case:

Timing and sequence of surgery ( which fx to fix first)
Pt positioning
Implant(s)

Thank you in advance for any feedback.

John Schlechter, DO
Resident Orthopaedic Surgery
Riverside County Medical Center
Moreno Valley, CA



Finding fabulous fares is fun.
Let Yahoo! FareChase search your favorite travel sites <http://farechase.yahoo.com/promo-generic-14795097;_ylc=X3oDMTFtNW45amVpBF9TAzk3NDA3NTg5BF9zAzI3MTk0ODEEcG9zAzEEc2VjA21haWx0YWdsaW5lBHNsawNxMS0wNw--> to find flight and hotel bargains.


M.L. Chip Routt, Jr.,M.D.
Professor-Orthopedic Surgery
Harborview Medical Center
325 Ninth Avenue
Box 359798
Seattle, WA 98104-2499
phone 206-731-3658
FAX 206-731-3227
--






Looking for earth-friendly autos?
Browse Top Cars by "Green Rating" at Yahoo! Autos' Green Center.

Jeffrey J Brooks, MD
Hand & Upper Extremity Surgery
Orthopaedic Trauma Surgery


Orthopaedic Surgery & Sports medicine center
1290 Summer Street, #4400
Stamford, CT 06905
(203) 323-7331


The information contained in this electronic mail transmittal may contain healthcare information and is protected by law. This message is intended only for the use of the designated recipient(s) named above. If the reader of this transmission is not the intended recipient(s), you are notified that any disclosure, dissemination, distribution or duplication of its contents is strictly prohibited. If you have received this transmittal in error, please notify the sender by return e-mail and delete the transmittal immediately. Thank you.















____________________________________________________________________________________
Don't pick lemons.
See all the new 2007 cars at Yahoo! Autos.
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scottnelson at mail
New User

Feb 7, 2007, 1:48 PM

Post #10 of 10 (6462 views)
Shortcut
RE: [ORT-L] R HIP / FEMUR FX + L FEMUR FX [In reply to] Can't Post
John,

Why cephalomedullary nail for the L femur and not standard locking IMN? I
like the DHS and retrograde for the R.

Scott Nelson MD

_____

From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On Behalf
Of john schlechter
Sent: Wednesday, February 07, 2007 9:21 AM
To: ORT-L@www2.aaos.org
Subject: Re: [ORT-L] R HIP / FEMUR FX + L FEMUR FX

Jeff,
Supine - radiolucent table, Femoral neck was provisionally stabilized after
reduction with two pins one for the DHS screw and the second as a
derotational pin, DHS was placed, followed by retro IMR , second prep and
drape and then the left femur was fixed with a cephalomedullary nail on the
fracture table, hemilithotomy position.
----- Original Message ----
From: Jeff Brooks <jjbrooksmd@gmail.com>
To: ORT-L@www2.aaos.org
Sent: Wednesday, February 7, 2007 3:55:02 AM
Subject: Re: [ORT-L] R HIP / FEMUR FX + L FEMUR FX

Dear John,

What did you do with this difficult case?

Jeff


On Feb 1, 2007, at 2:25 PM, john schlechter wrote:



Dr. Routt,

Thank you for your reply. This maybe a stupid question. I am assuming that a
"frail nail" is a smaller diameter nail?

JS
----- Original Message ----
From: Chip Routt <mlroutt@u.washington.edu>
To: ORT-L@www2.aaos.org
Sent: Thursday, February 1, 2007 6:26:33 AM
Subject: Re: [ORT-L] R HIP / FEMUR FX + L FEMUR FX

Timing- now for the right, and now for the left if he remains well after the
right is completed.

Sequence - Right neck, right shaft, then left shaft.

2 positions - 2 drapes/preps, rolled oblique for both.

Implants - plenty of opinions exist for the right side...some would use neck
screws anteriorly after reduction, then with a slender reamed locked nail
pushed in behind the neck screws for the shaft...some will advocate a recon
nail for both...some will use a sliding screw for the neck then a retrograde
shaft nail...some would use the sliding neck screw and a shaft plate
also...lots of options.

I prefer excellent neck reduction either closed or open, screws high and low
anteriorly for it, then a frail locked nail slipped in behind the neck
screws for the shaft.

Some will also advocate hip capsulotomy as well to relieve capsular pressure
related issues...it's done when you choose ORIF of the neck.

The left shaft fracture should accommodate an antegrade reamed locked nail
after reduction, unless I've missed some detail on the films as shown.

I'd use 2 preps and drapes and assure that he's well after the right side
before rolling on to the left.

Easy on the reaming-

Chip








I was hoping to get some input on a few questions regarding the following
case.

33 yo male motocross rider crashed after a jump sustaining isolated
bilateral femur fxs, R side with a basicervical femoral neck and ipsilateral
mid-distal 1/3 shaft, L side with a subtroch/prox 1/3 femur fx. Pt was HD
stable, no LOC, GCS - 15, No other injuries, spines cleared.

Questions about this case:

Timing and sequence of surgery ( which fx to fix first)
Pt positioning
Implant(s)

Thank you in advance for any feedback.

John Schlechter, DO
Resident Orthopaedic Surgery
Riverside County Medical Center
Moreno Valley, CA



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M.L. Chip Routt, Jr.,M.D.
Professor-Orthopedic Surgery
Harborview Medical Center
325 Ninth Avenue
Box 359798
Seattle, WA 98104-2499
phone 206-731-3658
FAX 206-731-3227
--


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