2018 (Sept-Dec)

Question 1

What is the incidence of ipsilateral femoral neck fracture in patients with a femoral diaphyseal injury?

What is the incidence these associated fractures are missed?

Answer 1

2-9%

6-9%

Question 2

What position is the hip in that increases the chance of having an associated ipsilateral femoral neck fracture, if do have a diaphyseal femur fracture?

Answer 2

Hip flexed, abducted

If adducted, more likely acetabular fracture.

Question 3

Protocol to reduce missed diagnosis of ipsilateral femoral neck fracture in patients presenting with diaphyseal femur fracture?

Answer 3

By Tornetta

Dedicated AP pelvis, lateral hip; consider judet view
Negative CT scan is not conclusive;
Intra-op pre-fixation and post-fixation biplanar fluoroscopy is required;
Early post op xray and consider post-op CT scan

Question 4

Does a negative CT scan reliably show an ipsilateral femoral neck fracture in patients presenting with a diaphyseal femur fracture?

Answer 4

No- neither 2 or 3 mm cuts

Question 5

How quickly do patients with ipsilateral femoral neck and shaft fracture need stabilization/fixation?

Answer 5

No consensus, recommend less than 24 hours (based on isolated femoral neck fractures data)

Question 6

What Is the proper sequence if reduction/fixation in patients with ipsilateral femoral neck and shaft fractures?

Answer 6

No consensus,
Neck first bc requires anatomic reduction vs
Shaft first bc will aid reduction of neck

Either- use your own reasoning

Question 7

with ipsilateral femoral neck and shaft fractures?

Answer 7

No consensus,
Choice dual vs single

Recommend dual- retrograde nail and dhs

Question 8

What are the risks associated with IM nail fixation of humeral shaft fracture?

Answer 8

Shoulder complications (cuff injury), greater radiation exposure intra op, higher rate of revision surgery

Question 9

What nerve will you visualize and must protect when performing the distal incision to the humeral MIPO approach.

Answer 9

LABC n

Question 10

When deciding to treat a humeral shaft fracture surgically, how far from the joint line must the fracture be for the MIPO to be a viable option.

Answer 10

10-12cm

Question 11

What are the contraindication to MIPO approach of the humerus

Answer 11

• Pathologic fracture
• Advanced osteoporosis
• Associated vascular injuries
• Severe soft tissue compromise
• Active local infection
• Radial nerve palsy after penetrating trauma

Question 12

What is the overall benefit of MIPO of the humerus vs ORIF and IM nail

Answer 12

o Excellent functional outcomes
o Lower rate of iatrogenic radial nerve injury
o High rate of rapid union

Overall, lower risk of complications

Question 13

In the setting of acute shortening for complex pilon fractures, how much can you shorten acutely before you start to worry about vascular compromise

Answer 13

3cm

Question 14

What are the characteristics which allow for early fixation of pilon fractures

Answer 14

• closed fracture
• isolated injury
• orthopedic traumatologist
• adequate resources
• intervention within 12 hours (not absolute)

Question 15

What pattern/approach to pilon fractures have proven to be most resilient

Answer 15

• Anterolateral approach in combination with either medial or posterolateral

Question 16

Indications for transyndemostic fixation in setting of pilon fracture

Answer 16

• Low energy + compounding wounds with considerable comorbidities (diabetics or osteoporosis)
• Valgus distal tibia fractures with associated medial traction wounds

Question 17

Indications for acute shortening

Answer 17

• candidate not ideal for local rotation flap, skin grafts or free flap due to injury and patient factors
• as distal tibial metaphyseal fractures