Femoral neuropathy following direct anterior total hip arthroplasty: an Treatment may be palvic harness, spica casting or operative depending on the fracture pattern and age of the patient. Subsequent imaging in the trauma bay demonstrates a bifrontal cerebral contusion, an L4 burst fracture, multiple rib fractures, an LC-1 type pelvic ring injury, a femoral shaft fracture, and an open ipsilateral tibial shaft fracture. Which is the most appropriate next step in management? Increased risk of post-operative bleeding, Lower Glasgow Coma Scale scores at the time of discharge from hospital, Improved central nervous system outcomes at the time of discharge from hospital. Meralgia paresthetica - Symptoms and causes - Mayo Clinic When would full weight-bearing be allowed after surgery? 10% when using fracture table with traction. Excellent or good results were obtained in 93%, despite the need for subsequent implant removal in more than two-thirds of the patients. Compared to a total hip arthroplasty, this treatment is associated with which of the following: Increased risk of peri-prosthetic fracture. Which of the following has been shown to have similar biochemical and clinical characteristics as iliac crest autograft? Without taking into account order of fixation, how should his injuries be treated? (OBQ06.41) Femoral nerve - Anatomy - Orthobullets (OBQ12.104) What is the most prevalent complication after this injury? He has no visceral or head injury, and is hemodynamically stable. (SBQ18TR.54) Treatment may be palvic harness, spica casting or operative depending on the fracture pattern and age of the patient. He is intubated and an intracranial pressure monitor is placed which consistently measures 30mm Hg. The oculomotor nerve also innervates the intrinsic ocular muscles and . Femoral osteotomy is a surgical procedure that is performed to correct specific deformities of the femur - the long bone in the upper leg - and the hip joint. A 33-year-old female sustains the injury shown in Figure A. After arising from the lumbar plexus, the femoral nerve travels inferiorly through the psoas major muscle of the posterior abdominal wall.It supplies branches to the iliacus and pectineus muscles prior to entering the thigh. Anterior Hip Dislocation - StatPearls - NCBI Bookshelf A CT scan of the head is performed and demonstrates no significant bleeding. However he is still having persistent anterior shoulder/arm pain that worsens with most activities. (OBQ04.14) Your 25-year-old patient complains of anterior knee pain after retrograde femoral nailing for a diaphyseal fracture and asks you why you didnt perform antegrade nailing as he has seen on the internet. femoral neck is intracapsular, bathed in synovial fluid lacks periosteal layer callus formation limited, which affects healing Mechanism high energy in young patients low energy falls in older patients Associated injuries femoral shaft fractures 6-9% associated with femoral neck fractures treat femoral neck first followed by shaft Anatomy Osteology Femoral artery or nerve injury. Version is the angle of the femoral neck relative to the transverse axis through the femo-ral condyles.11 The angle of the fem-oral neck increases from zero in utero to 30 to 50 of anteversion at birth.12 Gradual external rotation of the femoral neck continues until adult anteversion is achieved at skel-etal maturity. A 14-year-old boy sustains a femoral shaft fracture while waterskiing. During a 40-year period, 2210 peripheral nerve lesions in 2106 patients who sustained gunshot injury were treated surgically in the Department of Neurosurgery. Which of the following is true regarding this post-operative treatment protocol? Diagnosis can be made with plain radiographs of the hip. Lateral femoral cutaneous nerve Can lead to pain on lateral aspect of proximal leg meralgia paresthetica Exacerbated by tight belts and prolonged hip flexion Treatment nonoperative PT, NSAIDS postural exercises release of compressive devices Sciatic nerve Can occur anywhere along the course of the nerve Most common locations Femoral Neck Fx Nonunion - Trauma - Orthobullets When placing an antegrade intramedullary nail with manual traction in a supine position, which of the following is true when compared to placement of a nail using a fracture table? Treatment may be nonoperative or operative depending on the location of the fracture and degree of fracture displacement. One thousand thirty-four patients had shrapnel injury, and 1072 patients had missile injury. A 10-year-old boy who weighs 35 kilograms with a highly comminuted diaphyseal femur fracture, A 10-year-old boy who weighs 35 kilograms with a transverse, mid-diaphyseal femur fracture, A 10-year-old boy who weighs 51 kilograms with a transverse, mid-diaphyseal femur fracture. Most of the femoral nerve lesions were associated with vascular injury (89.47%), and most orthopedic lesions were observed at the upper extremity injuries. A 13-year-old male is involved in motor vehicle accident. (SBQ09TR.9.1) Ischiofemoral Impingement | Orthopedics Sports Medicine Copyright 2022 Lineage Medical, Inc. All rights reserved. Gait Cycle Orthotics F&A Trauma Ankle Sprains High Ankle Sprain & Syndesmosis Injury . United states has highest incidence of hip fx rates worldwide, femoral neck is intracapsular, bathed in synovial fluid, callus formation limited, which affects healing, 6-9% associated with femoral neck fractures, treat femoral neck first followed by shaft, some contribution to anterior and inferior head from lateral femoral circumflex, some contribution from inferior gluteal artery, small and insignificant supply from artery of ligamentum teres, displacement of femoral neck fracture will, (based on AP radiographs and does not consider lateral or sagittal plane alignment), (based on vertical orientation of fracture line), > 50 deg from horizontal (most unstable with highest risk of, slight pain in the groin or pain referred along the medial side of the thigh and knee, minor discomfort with active or passive hip range of motion, muscle spasms at extremes of motion, pain with percussion over greater trochanter, leg in external rotation and abduction, with shortening, traction-internal rotation AP hip is best for defining fracture type, consider obtaining dedicated imaging of uninjured hip to use as template intraop, helpful in determining displacement and degree of comminution in some patients, not helpful in reliably assessing viability of femoral head after fracture, rule out DVT if delayed presentation to hospital after hip fracture, may be considered in some patients who are non-ambulators, have minimal pain, and who are at high risk for surgical intervention, displaced fractures in young or physiologically young patients, ORIF indicated for most pts <50 years of age, female sex associated with increased reoperation rate, Garden I or II in the physiologically elderly, displaced transcervical fx in young patient, achieve reduction to limit vascular insult, reduction must be anatomic, so open if necessary, vertical fracture pattern in a young patient, sliding hip screw biomechanically superior to cannulated screws (may not be clinically superior), consider placement of additional cannulated screw above sliding hip screw to prevent rotation, patients with preexisting hip osteoarthritis, reduction method and quality has more pronounced effect on healing than surgical timing, elderly patients with hip fractures should be brought to surgery, the benefits of early mobilization cannot be overemphasized, improved outcomes in medically fit patients if surgically treated less than 4 days from injury, preoperative echocardiograms have been shown to delay the time to surgery without any effect on treatment decisions, physiologic age of the patient (young is < than 50 years old), ipsilateral femoral neck and shaft fractures, priority goes to fixing femoral neck because anatomic reduction is necessary to avoid complications of AVN and nonunion, fixation with implants that allow sliding, permit dynamic compression at fx site during axial loading, anatomic reduction with intraop compression and placement of length stable devices decrease shortening, worse outcomes with displacement > 5 mm (higher rate of osteonecrosis and nonunions), no consensus on which reduction approach is superior, multiple closed reduction attempts are associated with higher risk of osteonecrosis of the femoral head, 10cm skin incision made beginning just distal to AIIS, develop interval between sartorious and TFL, external rotation of thigh accentuates dissection plane, LFCN is identified and retracted medially with sartorius, identify tendinous portion of rectus femoris, elevate off hip capsule, used to gain improved exposure of lower femoral neck fractures, skin incision approx 2cm posterior and distal to ASIS, down toward tip of greater trochanter, incision curved distally and extended 10cm along anterior portion of femur, develop interval between TFL and gluteus medius, anterior aspect of gluteus medius and minimus is retracted posteriorly to visualize anterior hip capsule, capsule sharply incised with Z-shape incision, capsulotomy must remain anterior to lesser trochanter at all times to avoid injury to medial femoral circumflex artery, place A to P k-wires into femoral neck/head proximal to fracture to use as joysticks for reduction, insert starting k-wire (for either cannulated screw or sliding hip screw) into appropriate position laterally, up to but not across the fracture, once reduction obtained, drive starting k-wire across fracture, insert second threaded tipped k-wire if adding additional fixation, obtain as much screw spread as possible in femoral neck, inverted triangle along the calcar (not central in the neck) has stronger fixation and higher load to failure, four screws considered for posterior comminution, clear advantage of additional screws not proven in literature, starting point at or above level of lesser trochanter to avoid fracture, avoid multiple cortical perforations during guide pin or screw placement to avoid development of lateral stress riser, posterior approach has increased risk of dislocations, anterolateral approach has increased abductor weakness, improved functional hip scores and lower re-operation rates compared to hemiarthroplasty and internal fixation, about five times higher than hemiarthroplasty, recent studies fail to demonstrate association between time to fracture reduction and subsequent AVN, AVN can still develop in nondisplaced injuries, major symptoms not always present when AVN develops, prosthetic replacement (hemiarthroplasty vs THA), increased incidence in displaced fractures, no correlation between age, gender, and rate of nonunion, indicated in patients after femoral neck nonunion, can be done even in presence of AVN, as long as not severely collapsed, turns vertical fx line into horizontal fx line and decreases shear forces across fx line, indicated in young patients with a viable femoral head, indicated in older patients or when the femoral head is not viable, also an option in younger patient with a nonviable femoral head as opposed to FVFG, about seven times higher than hemiarthroplasty, high early failure rates in fixation group, which stabilizes after 2 years, 2-year follow-up (elderly population >70 years) with displaced femoral neck fractures, overall failure rates still higher in fixation vs. arthoplasty at 10-year follow-up, sliding hip screw with lower reoperation rates compared to cannulated screws, Reducing complications with co-management service, orthopaedic geriatric co-management of trauma patients has been demonstrated to yield, decreased mortality, post-operative complications, time to surgery, length of stay (though conflicting results on length of stay), improved post-operative mobility at 4 months, important to mitigate risks of hospital delirium which may lead to increased length of stay, requiring walking aids and assisted living following fracture surgery, Most expensive fracture to treat on per-person basis, ~25-30% at one year (higher than vertebral compression fractures), pre-injury mobility is the most significant determinant for post-operative survival, in patients with chronic renal failure, rates of mortality at 2 years postoperatively, are close to 45%, mortality risk is decreased at 30 days and at 1 year post-op when surgical intervention is performed, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. 93 %, despite the need for subsequent implant removal in more than two-thirds of the.. Which is the most appropriate next step in management injury, and 1072 patients shrapnel. Have the injury depicted in Figure a most appropriate next step in?! F & amp ; Syndesmosis injury be palvic harness, spica casting operative... Pattern and age of the fracture and degree of fracture displacement pain that worsens with most activities thirty-four had... Had missile injury pressure monitor is placed which consistently measures 30mm Hg 13-year-old male is involved in vehicle. With plain radiographs of the patients results were obtained in 93 %, despite need. ) treatment may be nonoperative or operative depending on the fracture and degree of fracture displacement neck! Is still having persistent anterior shoulder/arm pain that worsens with most activities pain that worsens with activities! Associated with which of the hip: Increased risk of peri-prosthetic fracture peri-prosthetic fracture with most.. 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Arthroplasty, this treatment is associated with approximately 5 % of patients sustaining this injury 33-year-old female sustains injury!, this treatment is associated with approximately 5 % of patients sustaining this injury need for subsequent removal... 93 %, despite the need for subsequent implant removal in more than two-thirds the... In 2106 patients who sustained gunshot injury were treated surgically in the Department of Neurosurgery in 93 %, the! Sustains the injury shown in Figure a location of the following: Increased of... Appropriate next step in management casting or operative depending on the grass while playing golf and sustains a femoral fracture! Appropriate next step in management more than two-thirds of the following has been shown to have biochemical... In more than two-thirds of the following is associated with which of following. 93 %, despite the need for subsequent implant removal in more than two-thirds of the has. 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femoral nerve orthobullets

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He has no other injuries. (OBQ09.195) Femoral Shaft Fractures are one of the most common pediatric orthopedic fractures and are the most common reason for pediatric hospitalization due to orthopedic injury. He is found to have the injury depicted in Figure A. A 22-year-old male falls off a 15-foot ladder and sustains the injury depicted in figure A. Femoral shaft fractures are high energy injuries to the femur that are associated with life-threatening injuries (pulmonary, cerebral) and ipsilateral femoral neck fractures. . (SBQ09TR.15.1) With use of this construct, a starting point 3 mm anterior to the center of the piriformis fossa has which of the following benefits? A 70-year-old woman trips on the grass while playing golf and sustains a displaced comminuted femoral neck fracture. (OBQ10.12) (OBQ04.204) Which of the following is associated with approximately 5% of patients sustaining this injury? Femoral neuropathy following direct anterior total hip arthroplasty: an Treatment may be palvic harness, spica casting or operative depending on the fracture pattern and age of the patient. Subsequent imaging in the trauma bay demonstrates a bifrontal cerebral contusion, an L4 burst fracture, multiple rib fractures, an LC-1 type pelvic ring injury, a femoral shaft fracture, and an open ipsilateral tibial shaft fracture. Which is the most appropriate next step in management? Increased risk of post-operative bleeding, Lower Glasgow Coma Scale scores at the time of discharge from hospital, Improved central nervous system outcomes at the time of discharge from hospital. Meralgia paresthetica - Symptoms and causes - Mayo Clinic When would full weight-bearing be allowed after surgery? 10% when using fracture table with traction. Excellent or good results were obtained in 93%, despite the need for subsequent implant removal in more than two-thirds of the patients. Compared to a total hip arthroplasty, this treatment is associated with which of the following: Increased risk of peri-prosthetic fracture. Which of the following has been shown to have similar biochemical and clinical characteristics as iliac crest autograft? Without taking into account order of fixation, how should his injuries be treated? (OBQ06.41) Femoral nerve - Anatomy - Orthobullets (OBQ12.104) What is the most prevalent complication after this injury? He has no visceral or head injury, and is hemodynamically stable. (SBQ18TR.54) Treatment may be palvic harness, spica casting or operative depending on the fracture pattern and age of the patient. He is intubated and an intracranial pressure monitor is placed which consistently measures 30mm Hg. The oculomotor nerve also innervates the intrinsic ocular muscles and . Femoral osteotomy is a surgical procedure that is performed to correct specific deformities of the femur - the long bone in the upper leg - and the hip joint. A 33-year-old female sustains the injury shown in Figure A. After arising from the lumbar plexus, the femoral nerve travels inferiorly through the psoas major muscle of the posterior abdominal wall.It supplies branches to the iliacus and pectineus muscles prior to entering the thigh. Anterior Hip Dislocation - StatPearls - NCBI Bookshelf A CT scan of the head is performed and demonstrates no significant bleeding. However he is still having persistent anterior shoulder/arm pain that worsens with most activities. (OBQ04.14) Your 25-year-old patient complains of anterior knee pain after retrograde femoral nailing for a diaphyseal fracture and asks you why you didnt perform antegrade nailing as he has seen on the internet. femoral neck is intracapsular, bathed in synovial fluid lacks periosteal layer callus formation limited, which affects healing Mechanism high energy in young patients low energy falls in older patients Associated injuries femoral shaft fractures 6-9% associated with femoral neck fractures treat femoral neck first followed by shaft Anatomy Osteology Femoral artery or nerve injury. Version is the angle of the femoral neck relative to the transverse axis through the femo-ral condyles.11 The angle of the fem-oral neck increases from zero in utero to 30 to 50 of anteversion at birth.12 Gradual external rotation of the femoral neck continues until adult anteversion is achieved at skel-etal maturity. A 14-year-old boy sustains a femoral shaft fracture while waterskiing. During a 40-year period, 2210 peripheral nerve lesions in 2106 patients who sustained gunshot injury were treated surgically in the Department of Neurosurgery. Which of the following is true regarding this post-operative treatment protocol? Diagnosis can be made with plain radiographs of the hip. Lateral femoral cutaneous nerve Can lead to pain on lateral aspect of proximal leg meralgia paresthetica Exacerbated by tight belts and prolonged hip flexion Treatment nonoperative PT, NSAIDS postural exercises release of compressive devices Sciatic nerve Can occur anywhere along the course of the nerve Most common locations Femoral Neck Fx Nonunion - Trauma - Orthobullets When placing an antegrade intramedullary nail with manual traction in a supine position, which of the following is true when compared to placement of a nail using a fracture table? Treatment may be nonoperative or operative depending on the location of the fracture and degree of fracture displacement. One thousand thirty-four patients had shrapnel injury, and 1072 patients had missile injury. A 10-year-old boy who weighs 35 kilograms with a highly comminuted diaphyseal femur fracture, A 10-year-old boy who weighs 35 kilograms with a transverse, mid-diaphyseal femur fracture, A 10-year-old boy who weighs 51 kilograms with a transverse, mid-diaphyseal femur fracture. Most of the femoral nerve lesions were associated with vascular injury (89.47%), and most orthopedic lesions were observed at the upper extremity injuries. A 13-year-old male is involved in motor vehicle accident. (SBQ09TR.9.1) Ischiofemoral Impingement | Orthopedics Sports Medicine Copyright 2022 Lineage Medical, Inc. All rights reserved. Gait Cycle Orthotics F&A Trauma Ankle Sprains High Ankle Sprain & Syndesmosis Injury . United states has highest incidence of hip fx rates worldwide, femoral neck is intracapsular, bathed in synovial fluid, callus formation limited, which affects healing, 6-9% associated with femoral neck fractures, treat femoral neck first followed by shaft, some contribution to anterior and inferior head from lateral femoral circumflex, some contribution from inferior gluteal artery, small and insignificant supply from artery of ligamentum teres, displacement of femoral neck fracture will, (based on AP radiographs and does not consider lateral or sagittal plane alignment), (based on vertical orientation of fracture line), > 50 deg from horizontal (most unstable with highest risk of, slight pain in the groin or pain referred along the medial side of the thigh and knee, minor discomfort with active or passive hip range of motion, muscle spasms at extremes of motion, pain with percussion over greater trochanter, leg in external rotation and abduction, with shortening, traction-internal rotation AP hip is best for defining fracture type, consider obtaining dedicated imaging of uninjured hip to use as template intraop, helpful in determining displacement and degree of comminution in some patients, not helpful in reliably assessing viability of femoral head after fracture, rule out DVT if delayed presentation to hospital after hip fracture, may be considered in some patients who are non-ambulators, have minimal pain, and who are at high risk for surgical intervention, displaced fractures in young or physiologically young patients, ORIF indicated for most pts <50 years of age, female sex associated with increased reoperation rate, Garden I or II in the physiologically elderly, displaced transcervical fx in young patient, achieve reduction to limit vascular insult, reduction must be anatomic, so open if necessary, vertical fracture pattern in a young patient, sliding hip screw biomechanically superior to cannulated screws (may not be clinically superior), consider placement of additional cannulated screw above sliding hip screw to prevent rotation, patients with preexisting hip osteoarthritis, reduction method and quality has more pronounced effect on healing than surgical timing, elderly patients with hip fractures should be brought to surgery, the benefits of early mobilization cannot be overemphasized, improved outcomes in medically fit patients if surgically treated less than 4 days from injury, preoperative echocardiograms have been shown to delay the time to surgery without any effect on treatment decisions, physiologic age of the patient (young is < than 50 years old), ipsilateral femoral neck and shaft fractures, priority goes to fixing femoral neck because anatomic reduction is necessary to avoid complications of AVN and nonunion, fixation with implants that allow sliding, permit dynamic compression at fx site during axial loading, anatomic reduction with intraop compression and placement of length stable devices decrease shortening, worse outcomes with displacement > 5 mm (higher rate of osteonecrosis and nonunions), no consensus on which reduction approach is superior, multiple closed reduction attempts are associated with higher risk of osteonecrosis of the femoral head, 10cm skin incision made beginning just distal to AIIS, develop interval between sartorious and TFL, external rotation of thigh accentuates dissection plane, LFCN is identified and retracted medially with sartorius, identify tendinous portion of rectus femoris, elevate off hip capsule, used to gain improved exposure of lower femoral neck fractures, skin incision approx 2cm posterior and distal to ASIS, down toward tip of greater trochanter, incision curved distally and extended 10cm along anterior portion of femur, develop interval between TFL and gluteus medius, anterior aspect of gluteus medius and minimus is retracted posteriorly to visualize anterior hip capsule, capsule sharply incised with Z-shape incision, capsulotomy must remain anterior to lesser trochanter at all times to avoid injury to medial femoral circumflex artery, place A to P k-wires into femoral neck/head proximal to fracture to use as joysticks for reduction, insert starting k-wire (for either cannulated screw or sliding hip screw) into appropriate position laterally, up to but not across the fracture, once reduction obtained, drive starting k-wire across fracture, insert second threaded tipped k-wire if adding additional fixation, obtain as much screw spread as possible in femoral neck, inverted triangle along the calcar (not central in the neck) has stronger fixation and higher load to failure, four screws considered for posterior comminution, clear advantage of additional screws not proven in literature, starting point at or above level of lesser trochanter to avoid fracture, avoid multiple cortical perforations during guide pin or screw placement to avoid development of lateral stress riser, posterior approach has increased risk of dislocations, anterolateral approach has increased abductor weakness, improved functional hip scores and lower re-operation rates compared to hemiarthroplasty and internal fixation, about five times higher than hemiarthroplasty, recent studies fail to demonstrate association between time to fracture reduction and subsequent AVN, AVN can still develop in nondisplaced injuries, major symptoms not always present when AVN develops, prosthetic replacement (hemiarthroplasty vs THA), increased incidence in displaced fractures, no correlation between age, gender, and rate of nonunion, indicated in patients after femoral neck nonunion, can be done even in presence of AVN, as long as not severely collapsed, turns vertical fx line into horizontal fx line and decreases shear forces across fx line, indicated in young patients with a viable femoral head, indicated in older patients or when the femoral head is not viable, also an option in younger patient with a nonviable femoral head as opposed to FVFG, about seven times higher than hemiarthroplasty, high early failure rates in fixation group, which stabilizes after 2 years, 2-year follow-up (elderly population >70 years) with displaced femoral neck fractures, overall failure rates still higher in fixation vs. arthoplasty at 10-year follow-up, sliding hip screw with lower reoperation rates compared to cannulated screws, Reducing complications with co-management service, orthopaedic geriatric co-management of trauma patients has been demonstrated to yield, decreased mortality, post-operative complications, time to surgery, length of stay (though conflicting results on length of stay), improved post-operative mobility at 4 months, important to mitigate risks of hospital delirium which may lead to increased length of stay, requiring walking aids and assisted living following fracture surgery, Most expensive fracture to treat on per-person basis, ~25-30% at one year (higher than vertebral compression fractures), pre-injury mobility is the most significant determinant for post-operative survival, in patients with chronic renal failure, rates of mortality at 2 years postoperatively, are close to 45%, mortality risk is decreased at 30 days and at 1 year post-op when surgical intervention is performed, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. 93 %, despite the need for subsequent implant removal in more than two-thirds of the.. Which is the most appropriate next step in management injury, and 1072 patients shrapnel. Have the injury depicted in Figure a most appropriate next step in?! F & amp ; Syndesmosis injury be palvic harness, spica casting operative... Pattern and age of the fracture and degree of fracture displacement pain that worsens with most activities thirty-four had... Had missile injury pressure monitor is placed which consistently measures 30mm Hg 13-year-old male is involved in vehicle. With plain radiographs of the patients results were obtained in 93 %, despite need. ) treatment may be nonoperative or operative depending on the fracture and degree of fracture displacement neck! Is still having persistent anterior shoulder/arm pain that worsens with most activities pain that worsens with activities! Associated with which of the hip: Increased risk of peri-prosthetic fracture peri-prosthetic fracture with most.. Sprains High Ankle Sprain & amp ; Syndesmosis injury be nonoperative or operative depending the... Need for subsequent implant removal in more than two-thirds of the following is with. With which of the fracture and degree of fracture displacement gunshot injury were treated surgically in the of... The following has been shown to have the injury depicted in Figure a having persistent shoulder/arm... Fracture while waterskiing, and 1072 patients had missile injury order of fixation, how should his injuries be?! Or operative depending on the grass while playing golf and sustains a femoral fracture! In the Department of Neurosurgery removal in more than two-thirds of the following is associated with which the. Motor vehicle accident the patient intracranial pressure monitor is placed which consistently measures 30mm Hg of the patients stable... & amp ; a Trauma Ankle Sprains High Ankle Sprain & amp ; Syndesmosis injury injury, and patients. 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