← All decks
The first 25 slides, exactly as they appear. The full deck has 91 content slides.
Orthopaedics
Subtrochanteric Femoral Fractures
Built from Tang — Orthopaedic Trauma Vol 2: Lower Extremity
What’s inside
9 sections · 91 slides
Understanding the Injury
What it is, why it is hard to heal
- What is a subtrochanteric fracture?
- Two numbers that shape your approach
- Why these fractures are notorious for not healing
- Koch's diagram of femoral load zones
- The biomechanics: a bone under lopsided load
- How muscle pull displaces the fragments
- Muscles pull the pieces apart
- The counter-intuitive rule: do NOT pull hard
Mechanism and Classification
How it breaks, and how we name the pattern
- What causes the break
- Fracture after cannulated-screw fixation
- How classification evolved
- Seinsheimer classification of fractures
- Seinsheimer classification at a glance
- Which patterns are dangerous, and why
- Radiographs of a Type IIa and Type V fracture
Assessment
Reading the patient and the films
- Clinical assessment at the bedside
- Pathological fracture from bone destruction
- Do not forget blood loss and hidden pathology
- Imaging assessment
Surgical Treatment
Choosing and executing the fixation
- Who needs surgery, and the rare exceptions
- Non-surgical traction at 90-degree flexion
- Two implant families, matched to the pattern
- Why DHS is the wrong tool here
Closed Reduction and Nailing
Step by step down the marrow canal
- Choosing the table position
- Lateral decubitus positioning
- Reduce before you ream - and control rotation
- Controlling rotation under fluoroscopy
- Reading the displacement guides the reduction
- Reducing minor abduction and flexion
- A toolbox of reduction tricks
- Reducing a flexed, abducted fragment (1)
- Reducing a flexed, abducted fragment (2)
- Reducing a flexed, abducted fragment (3)
- Reducing a medially displaced distal fragment
- Finding the entry point for the nail
- Nail entry on the greater trochanter
- Guide-wire entry on the coronal thirds
- Opening and reaming the canal
- Opening and reaming the medullary cavity
- Passing the main nail
- Rotating the guider while advancing the nail
- Locking into the femoral head
- Reconstruction screws into the femoral neck
- Locking the far end: the full-circle technique
- Distal locking: full-circle technique (1)
- Distal locking: full-circle technique (2)
- Distal locking: full-circle technique (3)
- Capping the nail and getting moving
- Case: closed reduction and nailing
Open Reduction and DCS Plating
When a plate beats a nail
- Reduce gently, protect the medial blood supply
- Reducing with a pointed clamp
- Setting the DCS into the head and neck
- Marking neck direction with a Kirschner wire
- Placing the DCS guide wire
- Reaming, seating the screw, and adding stability
- Depth measurement, reaming, and tapping
- DCS seated, wrench parallel to the shaft
- Anti-rotation cancellous lag screws
- Simple vs comminuted: two fixation philosophies
- Restoring the anterior bow
- DCS fixation of a Type V fracture
- After DCS plating
Experiences and Lessons
Reaming pitfalls and fixation principles
- Why we ream - and the traps of reaming
- Fat embolism and gentle nail insertion
- Principles of plate-screw fixation
- Why protect the medial (posteromedial) bone fragment above all else?
Complications and Their Prevention
Varus collapse and nonunion
- Varus deformity: the classic failure
- Checking alignment on the table - and the cut-out risk
- Type IV fracture with postoperative varus (1)
- Type IV fracture with postoperative varus (2)
- Type IV fracture with postoperative varus (3)
- Nonunion, part 1: a lost medial buttress
- Nonunion from a destroyed medial blood supply
- Nonunion, part 2: a gap that is too wide
- Type IIIB nonunion from a wide gap (1)
- Type IIIB nonunion from a wide gap (2)
Summary
The essentials in one place
- Three ideas to carry away
- Key take-home messages
- References (1/2)
- References (2/2)
- Orthopaedic Trauma Surgery - Volume 2: Lower Extremity