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The first 25 slides, exactly as they appear. The full deck has 98 content slides.
Orthopaedics
Femoral Shaft Fractures
Built from Tang — Orthopaedic Trauma Vol 2: Lower Extremity
What’s inside
13 sections · 98 slides
Overview
- What this deck will teach you
The Injury in Context
What a femoral shaft fracture is and how common it is
- Defining the femoral shaft fracture
- Femoral shaft fractures by the numbers
- Who breaks their femoral shaft, and why it matters
Applied Anatomy
Blood supply, muscles, bow, isthmus, and mechanics
- Where the femoral shaft gets its blood
- Blood supply of the femoral shaft
- The muscles that pull the broken pieces apart
- How fracture level dictates displacement pattern
- Two shape features every implant must respect
- The forward curve of the femoral shaft
- The femoral medullary isthmus
- The femur as a loaded beam: tension and compression
- Tension and compression sides of the femur
- The linea aspera: a landmark to protect
Mechanism and Classification
How the break happens and how we name the pattern
- Direct versus indirect force
- Reading the fracture from its shape
- The AO classification: a shared language for fractures
- AO classification of femoral shaft fractures
Assessing the Patient
The whole body, not just the bone
- Clinical assessment: expect company
- Staged emergency care after severe trauma
- Grading the whole patient before deciding surgery
- Overall-condition assessment chart
- A polytrauma patient graded at admission (radiographs)
- The same polytrauma patient: wounds and grading
- Imaging: look above and below the break
- Screening for associated fractures and vessel injury
Principles of Surgical Treatment
Why almost every shaft fracture is fixed, and how the patient's grade decides when
- Why surgery is almost always the answer
- Matching the operation to the patient's condition
- Damage control then staged definitive fixation
- Second-stage definitive fixation once stable
- How associated injuries change the plan
Choosing the Fixation
Antegrade nail, retrograde nail, plate, or external frame
- Antegrade nailing: the workhorse
- When to nail from the knee instead (retrograde)
- Floating knee fixed through one incision
- When to plate, and when to use an external frame
Antegrade Intramedullary Nailing
Positioning, reduction, and getting rotation right
- Positioning for antegrade nailing
- Lateral decubitus position for antegrade nailing
- Reducing the fracture and locking the nail
- Pre-bent guide wire aiding reduction
- Proximal locking options for the nail
- The hardest part: restoring rotation
- Reading the lesser trochanter to judge rotation
- Cortical mismatch signals rotational deformity
- Fine points that make or break the result
- Nonunion after a too-short distal locking screw
- Salvage of the failed nailing with plates and graft
- Type C fracture healed with oblique proximal locking
Retrograde Intramedullary Nailing
Nailing the femur upward from the knee
- Positioning and the entry approach
- Supine position for retrograde nailing
- Entry incision through the patellar ligament
- Finding the exact entry point
- Retrograde nail entry point at Blumensaat's line
- Exposing the intercondylar fossa for the guide wire
- Reaming, seating, and locking the nail
- Reaming, nail insertion, and locking
- Type A3 transverse fracture treated retrograde
- Blocking screws and correct screw length
- Blocking-screw techniques by fracture type
- Judging distal locking screw length
Open Reduction and Plating
The lateral approach and matching the plate to the fracture
- Positioning and the lateral surgical approach
- Supine position for the lateral open approach
- Arc-shaped lateral thigh incision
- The lateral surgical approach to the femur
- Two philosophies of plating
- Lag screw and protective plate for a type B fracture
- Bridge plating for complex fractures
- Bridge plating for type B3 and C fractures
- Type A2 fracture healed with lag screw and plate
Treating Nonunion
When the bone will not heal, and the MDC-LP anterior technique
- Why nonunion is so hard, and the options
- The MDC-LP: a smarter augmentation plate
- The multidimensional cross-locking plate (MDC-LP)
- The anterior approach that makes it work
- Anterior approach to femoral nonunion
- MDC-LP augmentation via the anterior approach
Complications and Prevention
The classic ways fixation fails, and how to avoid them
- Pitfalls of intramedullary nailing
- Varus malunion from a lateral entry point
- Pitfalls of plate-and-screw fixation
- Nonunion from a poor plate-screw strategy
- Plate breakage from a missing medial cortex
Bringing It Together
The core lessons in one place
- Three principles that run through the whole topic
- Key takeaways to remember
- References (1/3)
- References (2/3)
- References (3/3)
- Orthopaedic Trauma Surgery - Volume 2: Lower Extremity