Bilat Femur 1

8/8/2019 Bilat Femur 1

1/22

Pre-operative Conference

Trauma 4 Service

Jafer Terrence Lim, M.D.


2/22


3/22

History of Present Illness

1 day PTC

Patient was run over by a jeepney which was

not able to stop on time.

Patient was brought to a local hospital in

Lucena where xrays and splinting were done

and was advised transfer to POC


4/22

Physical Examination

Conscious, coherent, slightly agitated, stretcher-borne,with IV line and indwelling foley catheter. Splints werealso noted on bilateral lower extremity.

BP- 90/60 PR 110 RR 18 T- afebrile (+) Pale palpebral conjuctiva, anicteric sclera

Adynamic precordium, AB 5th LICS MCL, (-) murmurs

Flat abdomen, (-) tenderness, NABS

(+) tenderness and swelling of R thigh and tendernesson left distal thigh, (+) multiple abrasions on bilateralupper extremity and R lower extremity. No lacerations,avulsions, open wound, pulses full and equal


5/22

Review of Systems

(-) cough

(-) loss of consciousness

(-) headache

(-) vomitting

(-) dizziness

(-) paresthesia

(-) abdominal pain

(-) hematuria

(-) diarrhea

(-) constipation

(-) weakness


6/22


7/22

At the ER

Xrays

CBC


8/22

Patients Xrays


9/22

CBC results showed hemoglobin of 0.74 and

hematocrit of 24%


10/22

Diagnosis

Fracture, closed, complete, comminuted,

displaced, middle third, femur, right. AO/OTA

32-B1

Fracture, closed, complete, displaced,

supracondylar, femur, left. AO/OTA 32-A2


11/22

Plan

CR pinning under image intensifier,

supracondylar femur, left.

Minimally Invasive Plate Osteosynthesis(MIPO), femur, right.


12/22

Distal Femur Fixation


13/22

Midshaft Fixation


14/22

THANK YOU!!!

GOODMORNING!!!


15/22

All Types of Operative Treatment versusNonoperative Treatment

Good to moderate evidence (Grade A to B) from 2RCTs,

1 systematic review, 1 prospective cohort study, and17 retrospective cohort studies.

8 Operative treatment reduces malunion rate (OR0.54 [95% CI 0.36, 0.81]).

8 Operative treatment reduces total adverse events(OR 0.74 [95% CI 0.57, 0.97]).

Pediatric Femoral Fractures: A Systematic Review of 2422 Cases

Rudolf W. Poolman, MD,* Mininder S. Kocher, MD, and Mohit Bhandari, MD*

Evidence-Based Orthopedic Trauma


16/22

Submuscular bridge plating offers advantages of increasedstability, avoidance of pin tract infections, early mobilitywithout bracing, avoidance of the growth plates and

preservation of proximal femoral blood supply. Complications were infrequent and the authors concluded

that this technique offered adequate stability for earlyfunctional treatment and healing of all pediatric femoralshaft fractures.

For most patients, a 4.5-mm, narrow, low-contact dynamiccompression plate was used. By 12 weeks, bony union wasseen in all patients.

Advances in the surgical management of pediatric femoral shaft fractures

Marshall A. Kuremsky and Steven L. FrickCurrent Opinion in Pediatrics 2007, 19:5157


17/22

Unstable, complex (multifragmentary) and

significantly displaced high energy shaftfractures are treated operatively. Transverse or

short oblique shaft fractures in patients


18/22

We recommend hardware removal after

complete fracture healing, usually in 6 to 12

months. Implants left in the growing child

could become buried deep inside of the bone,

or cause periprosthetic fractures and/or

eventually impede adult reconstruction.

Current Concepts in Pediatric Femur Fracture Treatment

Enes Kanlic, MD; Miguel Cruz, MD

OrthoSuperSite , Pediatric Orthopedics, Dec. 1, 2007


19/22

Femoral fractures commonly are treated with

operative stabilization in children with

multiple injuries.

The femur can be stabilized with smooth

Steinmann pins or cannulated screws,

depending on the amount of displacementand the type of fracture.

Instructional Course Lectures, The American Academy of Orthopedic Surgeons

Orthopaedic Treatment of Fractures of the Long Bones and Pelvis in

Children who have multiple injuries.Vernon T. Tolo

J Bone Joint Surg Am. 2000; 82: 272-80


20/22

Percutaneous crossed Steinmann pins are

useful to hold supracondylar distal femoral

fractures. This allows full extension of the

knee.

These pins are left protruding through the skin

and are removed on an outpatient basis threeto four weeks after insertion.


Orthopaedic Treatment of Fractures of the Long Bones and Pelvis in

Children who have multiple injuries.Vernon T. Tolo



21/22

Open reduction with AO plate fixation has beenshown to be successful in treating femoral

fractures in children who have multiple injuries. This is a particularly effective technique when

there is an injury of the femoral artery needingrepair adjacent to the fracture.

A disadvantage of fixation with a plate is that asecond operative procedure is needed in order toremove the plate.


Orthopaedic Treatment of Fractures of the Long Bones and Pelvis inChildren who have multiple injuries.

Vernon T. Tolo



22/22

Rush-pin fixation of supracondylar and intercondylar fractures of the femur

KD Sholbourne and FR Brueckmannd, JBJS Am. 1982; 64-169

The Rush-pin

supracondylartechnique offers

enough stability to

allow early knee motion

and has the advantagesof both open and closed

techniques in managing

this type of fracture of

the femur.

Bilat Femur 1

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