Chapter 100 -Fractures of the Femoral Shaft and Distal Femur

Question 1

deforming forces in proximal femoral shaft fractures

Answer 1

• abductors on the GT - proximal segment varus
• iliopsoas on the LE - proximal segment procurvatum
• adductors all along the distal segment - varus

Question 2

what percentage of femoral shaft fractures have a concomitant femoral neck fracture?

Answer 2

between 1-9%

up to 50% of these are missed

Question 3

what is the femoral neck fracture orientation if associated with a femoral shaft?

Answer 3

vertical

Question 4

indications for retrograde femoral nail

Answer 4

• ipsilateral pelvis/acetabulum fracture you are trying to avoid incisions for
• bilateral femurs (same time/draping)
• morbid obesity
• pregnancy (lower radiation to fetus)
• floating knee - ipsilateral tibial shaft fracture

Question 5

patella baja may require what for a retrograde nail?

Answer 5

arthrotomy rather than perc

Question 6

what should you do after completion of retrograde nail?

Answer 6

fluoro hip to eval for hip fracture
also check rotational profiles with lesser troch of other side
ligamentous knee exam

Question 7

benefits of antegrade nail

Answer 7

decreased risk of varus

Question 8

downside of piriformi

Answer 8

may result in more muscle and tendon damage, and possibly to the blood supply to the femoral head
also an anterior start point is a stress riser for femoral neck fractures 2/2 hoop stresses

Question 9

risk of wht type of malreduction with femoral shaft fixation on a fracture table

Answer 9

internal rotation malreduction

Question 10

single construct fixation of a neck/shaft is associated with what?

Answer 10

femoral neck fracture displacement, loss of reduction, malreductionof the neck

Question 11

order of priority of neck/shaft

Answer 11

fix the neck first - decreased risk of damaging blood supply to head with manipulation of the shaft, then fix the shaft

Question 12

treatment of fat emboli syndrome

Answer 12

ventilation with high PEEP

Question 13

distal femur is in what degree of physiologic varus/valgus

Answer 13

9degrees of valgus

Question 14

deforming forces on the distal femur

Answer 14

gastrocs pull the distal fragment into extension leading to recurvatum deformity

Question 15

hoffa fragment

Answer 15

coronal plane fragment, most commonly found in the posterior lateral femoral condyle

Question 16

when performing a retrograde nail thru a tka what is the deformity risk?

Answer 16

box places the start point too posterior -> extension deformity

Question 17

what will posterior plate placement for distal femur fractures cause?

Answer 17

valgus and recurvatum deformities