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Subtrochanteric Fractures

Subtrochanteric Fractures. Su. Lisa K. Cannada , MD Professor Program Director. AVOIDING THIS!. Objectives. How I Handle These? Do I Bone Graft? What am I worried about? Let’s Make it Easy. How Do I Handle These?. Understand Deforming Forces. Positioning: Fracture Table.

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Subtrochanteric Fractures

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  1. Subtrochanteric Fractures Su Lisa K. Cannada, MD Professor Program Director

  2. AVOIDING THIS!

  3. Objectives • How I Handle These? • Do I Bone Graft? • What am I worried about? • Let’s Make it Easy

  4. How Do I Handle These?

  5. Understand Deforming Forces

  6. Positioning:Fracture Table

  7. Getting Best Images Not the best way to get AP Better way to obtain AP

  8. Getting Best Images How to obtain lateral w/flouro Mark on machine rotation to obtain desired view

  9. Getting Started Landmarks outlined and ideal location for insertion of starting guide pin

  10. Ideal Starting Point

  11. Opening Reamer Tip: Stop at the lesser trochanter

  12. Guidewire Making sure you are centered with guidewire on both views

  13. Tissue Protector for reaming. Ball tip in place to maintain reduction Getting Prepared for Nail

  14. C-Arm • Know your tech and communicate • Make sure you can image everything • Entrance site • Fracture • Interlocking holes • If you can’t see it, don’t start!!!

  15. Do I Bone Graft?

  16. My Answer: NO • Reduce Fracture • Solid fixation • WBAT • BUT…one type make you think about this

  17. Case

  18. What am I Worried About?

  19. That Darn Anterior Bow

  20. Technical Consideration • Essentially all current nail designs have radius of curvature greater than native elderly femur…The nail is much straighter than the bow

  21. Always Get Full Length Femur Films

  22. The Starting Point: Don’t Be TOO Anterior True lateral view key

  23. The Finger Reducer

  24. Let’s Make it Easy!

  25. Fracture Alignment Nail Follows Path Of Reamer On Radiograph Reamer Trajectory In Proximal Fragment Dictates Reduction Tip: Don’t ream until reduced!

  26. Using the Tools • Use of Channel reamer or equivalent • Maintain portal • Decrease soft tissue damage • Prevent proximal malunions (Russell, OTA 2006)

  27. Reduction Aids • “Finger” reducer may be helpful • Guide wire does not reduce fracture, finger does

  28. Reduction Aids • Ball spike pusher • May use Schantz pins • Strategic placement • Anterior/lateral

  29. TAD Matters Still go for </= 25 in IMN

  30. A Wire is NOT a Failure!

  31. Make it Easy!

  32. Have to Maintain Reduction

  33. After its Over

  34. What is Our Role? • Define condition • At a minimum, start on calcium and vitamin D • Not only prevents further fractures, but saves lives • Our patients listen..to their surgeons

  35. Examples of household hazards Decorations on railing Throw rugs with edge curled up: Watch out!

  36. Summary • Fracture Table • See before you start • OK to open • Reduction aids • Remember: Why did the fracture happen?

  37. Thank You! lisa.cannada@jax.ufl.edu

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