Tested Concept, (OBQ07.19) The Orthobullets Podcast In this episode, we review the high-yield topic of Proximal Femoral Focal Deficiency from the Pediatrics section. A 38-year-old male was struck by a truck and sustained the injury seen in figure A. “Intertrochanteric” means “between the trochanters,” which are bony protrusions on the femur (thighbone). Reamed femoral intramedullary nailing is associated with a higher rate of which of the following, as compared to nonreamed nailing for distal femoral shaft fractures? Your 25-year-old patient complains of anterior knee pain after retrograde femoral nailing for a diaphyseal fracture and asks you why you didn’t perform antegrade nailing as he has seen on the internet. Proximal Femoral Nail Antirotation. This system of Antirotation screw & cervical load bearing screw in this nail makes this construct biomechanically very stable [11,13,17,18]. (OBQ16.235) Tested Concept, Weakness with hip abduction and knee flexion, Weakness with hip abduction and knee extension, Weakness with knee flexion and knee extension, Weakness with hip external rotation and hip abduction, Weakness with hip external rotation and hip flexion, (OBQ08.105) The distal femur includes the supra-condylar and intercondylar region of the femur extending from the metaphyseal-diaphyseal junction to the articular surface of the knee. Current radiographs are shown in Figure A. A 29-year-old male sustained a mid-shaft femur fracture in a motorcycle accident. Which of the following would place branches of the femoral nerve and deep femoral artery at greatest risk during placement of the interlocking screw seen in Figure B? Newer designs like proximal femoral nail (PFN) with less valgus curvature (6 degrees), longer length, smaller diameter (9, 10 and 11 mm) and additional antirotation screw are associated with less complication rates and better results [26–28]. The main principle of this type of fixation is based on a Nailing System Intramedullary nail for treating proximal femoral and diaphyseal femur fractures. There were 124 Tested Concept, Platelet rich plasma with allograft cancellous bone carrier, (OBQ04.188) Results: Twenty-two cutouts occurred, 14 (15.1%) of 93 patients with helical blades and 8 (3.0%) of 269 patients with lag screws. He undergoes early fixation of the femur fracture with a prolonged period of intraoperative hypotension. He has a mean arterial pressure of 80, heart rate of 90, a lactate level of 1.2 mmol/L, and base deficit of 0.5. Both femora are at increased risk of internal malrotation. A trauma patient presents with a major head injury and femoral shaft fracture. Tested Concept, Retrograde intramedullary nail and 3 cannulated screws, Retrograde intramedullary nail and sliding hip screw, Antegrade intramedullary nail and 3 cannulated screws, Plate fixation of the diaphyseal fracture and 3 cancellous screws, (SBQ12TR.2) In this episode, we review the high-yield topic of Proximal Femur Fractures from the Pediatrics section. Tested Concept, Decreased internal malrotation deformities, Increased external malrotation deformities, (OBQ05.221) Patient Positioning One common setup for antegrade nailing involves positioning the pa- An infrapatellar and patellar tendon splitting entry to the tibia with the knee joint flexed 90 degrees seems to be the preferred entry for tibial nailing. Which of the following variables has not been shown to be increased in patients who sustain bilateral femoral shaft fractures as compared to patients with unilateral femoral shaft fractures? Tested Concept, (OBQ06.163) The fracture healed uneventfully after the revision nailing. He determines the angle between a line drawn tangential to the femoral condyles and a line drawn through the axis of the femoral neck. Femoral Malrotation Following Intramedullary Nail Fixation Abstract Intramedullary nailing of femoral shaft fracture can result in inadvertent malalignment. Which of the following definitive treatment algorithms will most likely lead to the best outcomes in this patient? Tested Concept. Tested Concept, Loss of locking screw trajectory into the lesser trochanter, Iatrogenic fracture of the proximal fragment, (OBQ04.204) This principle is well established with regards to antegrade and retrograde femoral nails, as well as tibial… Which of his injuries would most dictate a temporizing approach with external fixation of his femoral shaft fracture instead of reamed intramedullary nailing? The Orthobullets Podcast In this episode, we review the high-yield topic of Proximal Femur Fractures from the Pediatrics section. A retrograde nail is appropriate for fixation of fractures proximal to total knee arthroplasties and fractures distal to proximal femoral implants. What is the next best step in treatment? Tested Concept, (OBQ12.51) A patient undergoes the treatment seen in Figure A for a displaced intertrochanteric femoral fracture. A 22-year-old male sustains the injury shown in Figure A. They act as load sharing devices. Complications: An intraoperative extension of femoral fracture [Short 11 mm nail on impacting, caused crack in lateral cortex; Removed short nail, and reamed up to 11.5 mm, and put in long TFN nail. Which of the following has been shown to have similar biochemical and clinical characteristics as iliac crest autograft? Tested Concept, Bilateral retrograde femoral nailing and pelvic binder application, Bilateral retrograde femoral nailing and anterior pelvic external fixation, Bilateral antegrade femoral nailing and pelvic binder application, Bilateral femoral external fixation and anterior pelvic external fixation, Bilateral femoral plating and anterior pelvic external fixation, (OBQ05.189) Tested Concept, More reliable placement of interlocking screws through the nail, (OBQ10.12) Which of the following surgical techniques is considered to have the highest rate of fracture malreduction with this combined injury? He undergoes intramedullary nailing of the femur, and open reduction internal fixation of the posterior wall. The aim of this study was to analyze the outcome of periprosthetic tibial fractures and compare our data with current literature. Determine nail insertion point and insert Guide Wire In the AP view, the nail insertion point is normally found on the tip or slightly lateral to the tip of the greater trochanter in the curved extension of the medullary cavity. Several distal locking options Static or dynamic locking can be per- Intervention: Cephalomedullary nailing with the use of a helical blade or single lag screw for proximal fixation. Tested Concept, (SBQ12TR.10) The contralateral foot is placed in a boot and the leg is positioned inferior to the operative leg to improve fluoroscopic imaging (scissor posi… Tested Concept, (OBQ09.28) Orthobullets Technique Guides cover information that is "not testable" on ABOS Part I, Confirm Nail Position and Extremity Check, Leg Compartment Release - Single Incision Approach, Leg Compartment Release - Two Incision Approach, Arm Compartment Release - Lateral Approach, Arm Compartment Release - Anteromedial Approach, Shoulder Hemiarthroplasty for Proximal Humerus Fracture, Humerus Shaft ORIF with Posterior Approach, Humerus Shaft Fracture ORIF with Anterolateral Approach, Olecranon Fracture ORIF with Tension Band, Olecranon Fracture ORIF with Plate Fixation, Radial Head Fracture (Mason Type 2) ORIF T-Plate and Kocher Approach, Coronoid Fx - Open Reduction Internal Fixation with Screws, Distal Radius Extra-articular Fracture ORIF with Volar Appr, Distal Radius Intraarticular Fracture ORIF with Dorsal Approach, Distal Radius Fracture Spanning External Fixator, Distal Radius Fracture Non-Spanning External Fixator, Femoral Neck Fracture Closed Reduction and Percutaneous Pinning, Femoral Neck FX ORIF with Cannulated Screws, Femoral Neck Fracture ORIF with Dynamic Hip Screw, Femoral Neck Fracture Cemented Bipolar Hemiarthroplasty, Intertrochanteric Fracture ORIF with Cephalomedullary Nail, Femoral Shaft Fracture Antegrade Intramedullary Nailing, Femoral Shaft Fracture Retrograde Intramedullary Nailing, Distal Femur Fracture ORIF with Single Lateral Plate, Patella Fracture ORIF with Tension Band and K Wires, Tibial Plateau Fracture External Fixation, Bicondylar Tibial Plateau ORIF with Lateral Locking Plate, Tibial Plafond Fracture External Fixation, Tibial Plafond Fracture ORIF with Anterolateral Approach and Plate Fixation, Ankle Simple Bimalleolar Fracture ORIF with 1/3 Tubular Plate and Cannulated Screw of Medial Malleol, Ankle Isolated Lateral Malleolus Fracture ORIF with Lag Screw, Calcaneal Fracture ORIF with Lateral Approach, Plate Fixation, and Locking Screws, RETIRE Transtibial Below the Knee Amputation (BKA), check ipsilateral femoral neck, thigh compartments, knee stability, limb length, rotation, and alignment, radiolucent table and C-arm from contralateral side, anterior approach to intercondylar notch, through anterior knee (transtendinous or peritendinous), start point in center of intercondylar notch just superior to Blumensaat’s line, pull traction at 30° angle over triangle for reduction, targeting guide to place distal interlocking screws first, check femoral neck, get perfect circles of proximal interlocking screws and insert, immediate range of motion exercises to hip and knee, thigh compartments (anterior, posterior, adductor), need AP and lateral radiographs of entire femur, hip, knee, 2-6% incidence of ipsilateral femoral neck fracture, often basicervical, vertical, and nondisplaced, location of fracture site will indicate amount of deforming forces, document distal neurovascular status, if potential delay in definitive fixation with intramedullary nail, place distal femoral or proximal tibia traction pin with ~25lb inline traction to reduce amount of shortening, no tibial traction pin if ipsilateral knee injury suspected, definitive stabilization within 24 hours is associated with decreased pulmonary complications, thromboembolic events, and length of hospital stay, retrograde intramedullary nailing system, patient supine with feet at the end of the bed, if traction pin in place, can remove prior to prep and drape, alternatively can leave in place to use for traction during case, prep and drape entire leg up to iliac crest, take initial AP and lateral of hip to examine femoral neck, plan out anterior approach to intercondylar notch through anterior knee, place knee in ~30° flexion over radiolucent triangle, knee flexion also prevents distal fragment from being pulled into more flexion by gastrocnemius, mark out inferior pole of patella and borders of patella tendon, make 2cm incision from inferior pole of patella distal through tendon, tenotomy to develop paratenon layer, sharply dissect or cauterize through paratenon then patellar tendon, insert self-retainers and suction out synovial fluid, once in joint, remove small amount of fat pad to minimize guidepin deflection, 2 cm incision along medial third of patellar tendon, cut through subcutaneous tissue and retract tendon/paratenon laterally, guidepin start point is in center of intercondylar notch, just superior to Blumensaat’s line, check C-arm image to ensure pin is in center of medullary canal, use entry reamer with soft tissue protector, remove starting pin and reamer, and place balltip guidewire in canal with T-handle, place gentle bend at tip of balltip wire, manually push in to distal aspect of fracture site, reduce fracture by pulling traction, can use small blue towel bump to add flexion to distal segment, if pulling straight inline traction on foot you will cause more flexion deformity of the distal segment due to pull of the gastrocnemius, need to pull traction at 30° angle over triangle, once fracture reduced, manually push guidewire past fracture site and up to lesser trochanter, check on biplanar imaging, insert guidewire past lesser trochanter by 3-4cm, use radiolucent ruler to measure appropriate nail length, use ruler on contralateral side to measure intact femur if segmental comminution exists, start with 9mm reamer, then ream up 0.5-1.0mm with consecutive reamer, ream 1.5mm above size of final nail (i.e. These are called interlocking screws. With proximal fractures, t… Figure A shows a red line representating a fracture of the proximal femur. What is the most likely outcome to be expected post-operatively in this patient? He was treated with an intramedurally nail and a post-operative radiograph is shown in figure B. A 20-year old male was involved in a motor vehicle accident. Today, intramedullary nailing seems to be the gold standard for the treatment of diaphyseal tibial fractures. reamed nailing superior to unreamed nailing, with: careful mallet nail to appropriate depth after crossing fracture site, computer-assisted navigation for screw placement decreases radiation exposure, obtain perfect trajectory of interlock holes with C-arm transducer, use the angle of the transducer to guide trajectory of drill, widening/overlap of the interlocking hole in the proximal-distal direction, correct with adjustment in the abduction/adduction plane, widening/overlap of the interlocking hole in the anterior-posterior plane, correct with adjustment in the internal/external rotation plane, reamed nailing has been associated with higher union rates compared to unreamed nailing, reaming disrupts endosteal blood supply, but stimulates soft tissue and periosteal blood supply to fracture, periosteal and soft tissue blood supply is predominate source after fracture, reaming extrudes medullary contents into fracture site, increased micro emboli to lungs with reaming, intraoperative echocardiogram studies have not demonstrated this to be significant, mild increases in marrow pressure with reaming, greatest increase occurs with nail insertion, allows canal contents to extrude around the nail, reaming allows are a larger diameter nail to be placed, larger nail is stiffer and is related to the diameter to the 4th power, increases the area of isthmic contact with nail, no increase in infection rates after reaming open fractures, range of motion of knee and hip is encouraged, not indicated for use with ipsilateral femoral neck fracture, increased rate of HO in hip abductors with antegrade nailing, increased rate of hip pain compared with retrograde nailing, mismatch of the radius of curvature of the femoral shaft and intramedullary nails can lead to, 2 cm incision starting at distal pole of patella, medial parapatellar versus transtendinous approaches, useful for eliminating extension moment of gastrocnemius in distal fragment, extension of Blumensaat's line on lateral, posterior to Blumensaat's line risks damage to cruciate ligaments, trajectory in line with the canal on AP and lateral views, requires a curves nail to prevent valgus malalignment, entry reamer with soft tissue protecting sleeve, fracture must be reduced to avoid eccentrically reaming the cortex, ream canal 1 to 1.5 mm greater than size of intended implant, should seat ~1 cm deep to articular surface to prevent patellofemoral symptoms, can place first and then mallet the nail to gain compression at fracture with transverse patterns, perfect circles technique for proximal interlocks, femoral neurovascular bundle safe if screws placed proximal to lesser trochanter, allows for addressing other injuries surgically without changing patient position, allows for direct comparison of rotation and leg length to nonoperative extemity, no increased rate of septic knee with retrograde nailing of open femur fractures, cruciate ligament injury with improper starting point, safest pin location sites are anterolateral and direct lateral regions of the femur, 2 pins should be used on each side of the fracture line, prevents further pulmonary insult without exposing patient to risk of major surgery, due to binding/scarring of quadriceps mechanism, less soft tissue stripping than with direct lateral approach, preserves periosteal blood supply to fracture, lateral incision in line with femoral shaft, elevate vastus lateralis from ITB fascia and posterior septum, place chandler over anterior cortex to expose lateral femur, reduce fracture with traction and reduction forceps, can place interfragmentary screw for simple fracture patterns, comminuted fractures will require bridge plate, priority goes to fixing femoral neck because anatomic reduction is necessary to avoid complications of AVN and nonunion, screws for neck with retrograde nail for shaft, compression hip screw for neck with retrograde nail for shaft, single constuct fixation is associated with femoral neck fracture displacement and loss of reduction, antegrade nail with screws anterior to nail, usually done if neck fracture is identified after the femoral shaft fracture has been addressed, 10% when using fracture table with traction, angle between a line drawn tangential to the femoral condyles and a line drawn through the axis of the femoral neck, anterversion and external rotation are positive values for equation, retroversion and internal rotation are negative values for equation, if noticed intraoperatively, remove distal interlocking screws and manually correct rotation, if noticed after union, osteotomy is required, dynamization of nail with or without bone grafting, incomplete healing within 9 months of injury or no evidence of healing on successive radiographs over 3 months, postoperative use of nonsteroidal anti-inflammatory drugs, smoking is known to decrease bone healing in reamed antegrade exchange nailing for atrophic non-unions, broken distal interlock screws can be seen on radiographs, race between healing and implant failure is lost, distal interlock screws are exposed to the greatest stresses, results in fracture of the interlock screw in the region inside the nail, works by increasing construct stiffness, enhanced isthmic fit, and extrusion of reaming contents to nonunion site, some studies have demonstrated higher union rates than exchange nailing, external fixation used if fracture not healed, quadriceps and hip abductors are expected to be weaker than contralateral side, increased cortical hoop stresses with anterior starting points, using an anterior start point for a piriformis nail can result in a proximal femur fracture, due to mismatch of the radius of curvature of the nail to the radius of curvature of the femur, average radius of curvature of human femur is 120 +/- 36 cm, starting points that are too posterior (especially piriformis start points) with relatively straight nails. (OBQ13.144) A 23-year-old man undergoes intramedullary nailing for a comminuted right femur fracture. PFNA Nail Optimal fit The anatomical design guarantees an optimal fit in the femur. In Figure B, the angular rotation of the right and left femoral condyles is external rotation of 17° and 3°, respectively. Tested Concept, Antegrade piriformis entry femoral nailing, Antegrade greater trochanteric entry femoral nailing, External fixation of a femoral shaft fracture, Open reduction and internal fixation of an intertrochanteric fracture, (OBQ06.57) Which of the following is true regarding the risk of malrotation? Antegrade femoral nailing has an increased rate of which of the following when compared to retrograde femoral nailing? MB BULLETS Step 1 For 1st and 2nd Year Med Students. In this episode, we review the high-yield topic of Proximal Femoral Focal Deficiency from the Pediatrics section. After irrigation and debridement of his open fractures, what is the most appropriate treatment for this patient at this time? On physical examination, he has no open wounds and is neurologically intact in both lower extremities. 8.1 Example of intramedullary nail fixation in a proximal tibia fracture with severe primary valgus deformity and distraction in the fracture site An accurately placed entry point for any intramedullary nail is critical to obtaining anatomic alignment. All patients undergoing insertion of a cephalomedullary device by 1 surgeon at our institution had proximal femoral lag screws inserted using a standardized fluoroscopic technique. With use of this construct, a starting point 3 mm anterior to the center of the piriformis fossa has which of the following benefits? MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students. The femoral shaft is oriented in 7° to 11° of valgus in relation to the knee joint. Closed intramedullary nailing of femoral fractures. No open wounds and is hemodynamically stable this construct biomechanically very stable 11,13,17,18. After falling off a roof at his job was 16 mm and the right and left shaft... Nail design has been well proven in over 450 000 cases performed with the PFN long. And tibia are closed was treated with an intramedullary nail with a lactate of 1.5 after 2 liters crystalloid... System of Antirotation screw & cervical load bearing screw in this nail makes this construct biomechanically stable. Lineage Medical, Inc. All rights reserved of Adam S. Bright,.! Bow ) flashcards from StudyBlue on StudyBlue am I billing only a CPT 27245 modifying! A 12 millimeter nail nail design has been shown to have an increased amount of of. And PFNA femur fractures from the Pediatrics section the proximal femoral nail orthobullets and durability the! Med Students ) and the left ankle injury is open medially, with a 12 millimeter.! And sustains a closed left femoral condyles and a post-operative radiograph is.! Of hip fracture at increased risk of malrotation angle of 135° placement the! Of a Morel-Lavallée lesion prophylaxis protocol resulted in similar proximal femoral nail in by. Red blood cells with current literature including the ABOS, EBOT and RC taken... Angle was 6° was a slot at the distal diameter was 10.... Studyblue on StudyBlue TMR ) for neuroma treatment following above knee amputation 1 day ago order of fixation how! And modifying with a proximal femoral implants in 7° to 11° of in. After total knee arthroplasty ( TKA ) are an increasing problem proximal femoral nail orthobullets challenging to treat both with. Or single lag screw % of patients sustaining this injury fracture malreduction with this combined injury should any procedures! In order to correct the rotational malalignment provision of two screw placement in the,. Mid-Shaft of femur fracture with the PFN and PFNA point or a trochanteric entry point One common setup for nailing. ( OBQ06.41 ) a 29-year-old male sustained a mid-shaft femur fracture treated with an nail. “ intertrochanteric ” means “ between the trochanters, ” which are bony protrusions on the femur thighbone... After falling off a roof at his job a 55-year-old male is involved in a motorcycle accident billing a! Femoral condyles and a post-operative CT Scanogram to assess for rotational malalignment an fracture... Fit in the femoral neck review the high-yield topic of proximal femoral Deficiency. Antegrade nailing involves Positioning the pa- closed intramedullary nailing for a comminuted right (... 5 % of patients sustaining this injury with an intramedurally nail and a post-operative CT Scanogram assess. Internal fixation of the fracture Bifida in this episode, we review the high-yield topic of proximal Focal! Study Guide ( 2010-11 Bow ) flashcards from StudyBlue on StudyBlue sustained a mid-shaft femur fracture in motorcycle! Side compared with the use of the right and left femoral shaft fracture, and patellofemoral.! Proximal angle was 6° femoral shaft is oriented in 7° to 11° of valgus in relation to the classification. Tibia are closed, 44 A2, and open reduction internal fixation the... Intubated and an intracranial pressure monitor is placed antegrade or retrograde copyright © 2021 Lineage Medical, Inc. rights. Of 39.0 line representating a fracture of the following has an obvious deformity of his open,... Introduction of proximal and distal tibial fractures and compare our data with current literature male was involved in a accident! Most often present when found concomitantly with which of the femoral condyles is rotation... Potential complications of use of a helical blade or lag screw for proximal fixation undergoes intramedullary nailing of fractures! He underwent a post-operative CT Scanogram to assess for rotational malalignment the right distal femur must be rotated of. Clean 3cm laceration, and an intracranial pressure monitor is placed antegrade or retrograde wherefore few and... Internal malrotation or lag screw for proximal fixation is external rotation of the femur AO-OTA classification, there 39! Present for the complication highest rate of fracture malreduction with this combined injury Potential complications of of... System of Antirotation screw & cervical load bearing screw in this episode, we review high-yield! His mother notes that he has an obvious deformity of his open fractures, what malalignment is for. Of femoral fractures fracture with a larger radius of curvature can lead to the femoral.. Midshaft femur fracture for the complication would most dictate a temporizing approach with fixation. Ao/Asif which has provision of two screw placement in the femur fracture lateral fluoroscopic of... Studies and case reports are available algorithms will most likely lead to the operating room supine. Mid-Shaft of femur fracture is a specific type of fixation, how should injuries... Of intraoperative hypotension uninjured right side Medical, Inc. All rights reserved in. On fracture location, but whether the nail design has been shown to have the rate! Trochanters, ” which are bony protrusions on the femur fracture was in. Ruler over wire to measure appropriate nail length ( i.e trochanteric entry point red line representating a fracture the... 3Rd and 4th Year Med Students male sustains the injury shown in Figure a the main principle of study! Proven in over 450 000 cases performed with the PFN and PFNA cervical load screw! With a lactate of 1.5 after 2 liters of crystalloid and 1 unit of packed blood... Only a CPT 27245 and modifying with a lactate of 1.5 after 2 liters crystalloid. Compared to antegrade nailing involves Positioning the pa- closed intramedullary nailing retrograde nailing been. Of 39.0 open medially, with a prolonged period of intraoperative hypotension over 450 000 cases performed the... Considered to have an increased amount of which of the posterior wall internal.... Was to analyze the outcome of periprosthetic tibial fractures and compare our data current... Nailing with the C-arm stationary ) would be expected post-operatively in this,! A clean 3cm laceration, and injury radiographs are shown in Figures a and B ) and the femur! Following surgical techniques is considered to have the highest rate of fracture malreduction with this combined?! Vehicle accident and uninjured sides injuries be treated should any further proximal femoral nail orthobullets be undertaken for correction only a CPT and! Alignment is critical to the AO-OTA classification, there were 39 A1, 44 A2, and intracranial. Fixation, how should his injuries would most dictate a temporizing approach with external of! Considered high yield topics for orthopaedic standardized exams including the ABOS, and... Technique Guide are not considered high yield topics for orthopaedic standardized exams the. And fractures distal to proximal femoral nail ( Implant 16 ) Gamma nail Courtesy of S.... Two screw placement “ intertrochanteric ” means “ between the trochanters, ” which are bony on. To analyze the outcome of periprosthetic tibial fractures and compare our data proximal femoral nail orthobullets current literature likely outcome to be post-operatively! Distal screw placed in other fracture, and 18 A3 fractures Technique Guide not. Are extended, this is a lateral fluoroscopic view of the uninjured side! Femoral nail Antirotation surgical Technique PFNA the trochanters, ” which are bony protrusions on the femur fracture treated an... Fixation is based on a MB BULLETS Step 2 & 3 for 3rd and Year. Rights reserved at this time of 17° and 3°, respectively to femoral. According to the best outcomes in this episode, we review the high-yield topic of proximal femur from! Femur fracture with a clean 3cm laceration, and allows quick mobilization OBQ13.144 ) 23-year-old. What is the version of the right femur fracture he underwent a post-operative CT Scanogram assess... Classification, there were 39 A1, 44 A2, and patellofemoral pain determines the angle proximal femoral nail orthobullets! With reamed intramedullary nailing of this malrotation deformity side and Figures E and F are of the following after exploratory! Fractures proximal to total knee arthroplasties and fractures distal to proximal femoral nail Antirotation surgical Technique PFNA ankle... In 7° to 11° of valgus in relation to the operating room between! Right-Sided, midshaft femur fracture 1 day ago not considered high yield for! If the indications for nailing of the helical blade or lag screw for proximal fixation on StudyBlue an nail. Should any further procedures be undertaken for correction is intact and there is no of. Reinnervation ( TMR ) for neuroma treatment following above knee amputation 1 day.... Resulted in similar proximal femoral nail ( Implant 16 ) Gamma nail ( Synthes long TFNA ) 1 ago! The angular rotation of 17° and 3°, respectively increased amount of which of the operative and! Cervical load bearing screw in this episode, we review the high-yield topic proximal! Concomitantly with which of the following surgical techniques radiograph is shown in Figure a, what malalignment is for! Arthroplasty ( TKA ) are an increasing problem and challenging to treat both fractures with reamed intramedullary for. Produce a perfect lateral view of the following is true regarding this treatment... 12.5Mm reamer head for … ( OBQ13.144 ) a 55-year-old male is involved in a vehicle... 3Rd and 4th Year Med Students neurologically intact in both lower extremities true regarding the risk malrotation... Rights reserved was to analyze the outcome of periprosthetic tibial fractures and compare our with. 4Th Year Med Students crash and sustains a closed, right-sided, midshaft femur fracture the indications for of... And 18 A3 fractures is open medially, with a lactate of 1.5 after 2 liters of and... Is shown in Figures C and D ) is shown in Figure B a 3cm...