Ortho Oracle - orthopaedic operative atlas

Comminuted Femoral Shaft Fractures – Type IV

– Discussion: – see: Winquist Classification – sign of high energy trauma: more blood loss, systemic complications, and fat embolism syndrome; – all cortical contact is lost; – simple cloverleaf nails are contraindicated w/ type III and IV comminuted frxs because of risk of shortening of frx about nail; – small diameter nails fail to … Read more

Closed Reduction of Intertrochanteric Fractures

– Radiographic Findings:     – if possible intertrochanteric fractures should be closed reduced on the fracture table, prior to sterile draping;     – allows adjustment of patient position (should it be necessary) and ensures that all equipement is working properly (on occassion frx table will malfunction);     – radiographs are taken with special attention to cortical … Read more

Classification of Intertrochanteric Fractures

– See: Unstable Intertrochanteric Fractures:     – Type I:   non displaced, stable intertrochanteric s comminution;     – Type II:  stable, minimally comminuted, but displaced frx             – 36% of intertroch frx     – Type III: has a large posteromedial comminuted area and are unstable;           … Read more

Circumferential Growth

– Discussion:     – to understand functions of & reasons for haversian systems, one must consider manner in which diaphysis grows circumferentially;     – since bone is hard substance, it can grow only by adding new material to its surface;     – at birth, diaphyseal portion of human femur is tube about 6 mm … Read more

Arterial Supply to Femur

– See: – Blood Supply Femoral Head & Neck – Anatomy of Circulation: – mainly supplied by profunda femoris: – nutrient artery usually enters bone proximally and posteriorly along linea aspera; – usually there is only one nutrient artery (maximum of 2); – usually it comes of the 2nd perforating artery: – after giving off … Read more

AO/ASIF Femoral Distractor

Indications allows unobstructed view of articular surface of acetabulum; Technique proximal bolt is inserted in the iliac wing in its superior portion, just distal to thickened crest; proximal bolt must pass through portion of ilium in continuity w/ sacrum (or frx proximal to this point must be stabilized) prior to application of a distraction force; distal bolt … Read more

Antegrade IM Nailing Technique for Femoral Shaft Fracture

– Discussion: – retrograde IM nailing – Workup for Femoral Shaft Frx – PreOp Planning: – rule out femoral neck fracture: – Is Reconstruction Nailing of All Femoral Shaft Fractures Cost Effective? A Decision Analysis. – Diagnosis of femoral neck fracture associated with femoral shaft fracture: blinded comparison of computed tomography and plain radiography. – IM nailing of … Read more

Anatomy of Femur

– See: Arterial supply to Femur – Embryology of Proximal Femur: – upper end consists of head, neck, & greater & lesser trochanters at junction of the neck with the body; – develops from 4 separate ossification centers; – head forms roughly two-thirds of sphere whose surface is articular  except for fovea capitis femoris where … Read more

Femoral Shaft Fracture Menu

    (see: Synthes Femoral Products)  Workup for Femoral Shaft Frx (trauma workup) assessment of perfusion: damage control orthopaedics timing of surgery in orthopaedic patients with brain injury surgical timing and prevention of ARDS in patients with femur frx IM Nailing Technique Anatomy of Femur Arterial supply Canal Entry Point Comminuted Femoral Shaft Fractures Distal … Read more