Pre operative conference diaphyseal Femur.pptx

Femoral fracture

1. C.S. 49/M Community ambulator Construction worker CC: deformity left thigh NOI: Fall (Occupational ) TOI: 3pm DOI: 2/17/24 POI: Caloocan

2. Review of Systems General (-) decreased sensorium (-) weight loss (-) weakness (-) dizziness (-) LOC (-) weight loss Skin (-) jaundice (-) pallor (-) pruritus (-) rashes HEENT (-) decreased visual acuity (-) decreased hearing (-) nasal congestion Chest (-) chest pain (-) palpitations Respiratory (-) cough (-) dyspnea (-) difficulty of breathing Gastrointestinal (-) hematemesis (-) abdominal pain (-) melena Genitourinary (-) hypogastric pain (-) dysuria (-) gross hematuria (-) polyuria

3. Past Medical History (-) Hypertension (-) Diabetes Mellitus (-) PTB Personal & Social History Occasional alcoholic beverage drinker and non smoker Denies illicit drug use Family Medical History (-) Hypertension (-) Diabetes Mellitus (-) PTB Covid History ( - ) cough, (-) colds, fever, DOB, exposure vaccine:

4. GENERAL PHYSICAL EXAMINATION GEN : Conscious, coherent, stretcher borne GCS 15 E4, V5, M6 Stable vital signs 120/80 BP 88 HR; 22 RR; 37.0 T; 99 O2 Room Air HEENT : pink palpebral conjunctivae; anicteric sclerae; no naso aural discharge; no tonsillopharyngeal erythema RESPIRATORY : Symmetric chest expansion; no retractions; no abrasions, lacerations; clear breath sounds CARDIAC : Adynamic precordium, normal rate, regular rhythm, no murmurs ABDOMINAL : Flat, non-distended abdomen, no hematoma, no abrasions, no lacerations; normoactive bowel sounds; tympanitic; no liver enlargement; no splenic enlargement; non-tender on all quadrants GENITOURINARY : No hematuria, no dysuria

5. Focused PE: LEFT THIGH (+) left hip is flexed, abducted and externally rotated (+) deformity and tenderness left thigh TLL R:81cm TLL L: 79cm Able to plantarflex and dorsiflex ankle 2+ popliteal pulse, 2+ femoral pulse Crt<2s No neurological deficits Left ANTERIOR MEDIAL SUPERIOR

6. INJURY FILMS THIGH APL, LEFT THIGH APL, LEFT

7. Diagnosis Fracture closed complete displaced oblique middle third femur, left AO 32A3; Winquist and Hansen 0

8. Problem List Fracture of the middle third of the femur Unable to return to work immediately Anatomic reduction, and restore length, axis and rotation Encourage early ROMs of shoulder Early return to work and ambulation improve self image Goals

9. Non operative Closed reduction , skeletal traction, cast brace limited to instances in which devices for internal fixation are unavailable or in patients with significant medical comorbidities that make femoral stabilization impossible Patient is a bread-winner and thrives early return to work High risk of non-union Court-Brown CM Heckman JD McQueen MM Ricci WM Tornetta P McKee MD. Rockwood and Green's Fractures in Adults. Eighth ed. Philadelphia: Wolters Kluwer Health; 2015.

10. TREATMENT OPTIONS Advantages Disadvantages Remarks Non Operative Not indicated Unable to immediately get back to work Patient is a bread winner and early return to work is a must Open Reduction and Plate Fixation Patients with an extremely narrow medullary canal Fractures around or adjacent to a previous malunion Fractures extending proximally or distally into the pertrochanteric or metaphyseal region Associated vascular injury requiring repair Ipsilateral neck shaft fractures Fractures at or near previously place implants (e.g., periprosthetic or peri-implant fractures) No early weight bearing for the patient Court-Brown CM Heckman JD McQueen MM Ricci WM Tornetta P McKee MD. Rockwood and Green's Fractures in Adults. Eighth ed. Philadelphia: Wolters Kluwer Health; 2015, AO Surgery Refernce .

11. Intramedullary Fixation Smaller incisions, better cosmesis, less soft-tissue dissection, and lower risk for hardware prominence. A narrow canal that will not accommodate a nail Open growth plates Previous malunion that prevents nail placement History of intramedullary infection Immediate weight bearing

12. PROCEDURE: CLOSED REDUCTION POSSIBLE OPEN REDUCTION, ANTEGRADE, REAMED, INTRAMEDULLARY NAILING, FEMUR LEFT

13. Court-Brown CM Heckman JD McQueen MM Ricci WM Tornetta P McKee MD. Rockwood and Green's Fractures in Adults. Eighth ed. Philadelphia: Wolters Kluwer Health; 2015.

14. Pearls and pitfalls Court-Brown CM Heckman JD McQueen MM Ricci WM Tornetta P McKee MD. Rockwood and Green's Fractures in Adults. Eighth ed. Philadelphia: Wolters Kluwer Health; 2015.

15. Post-operative care Court-Brown CM Heckman JD McQueen MM Ricci WM Tornetta P McKee MD. Rockwood and Green's Fractures in Adults. Eighth ed. Philadelphia: Wolters Kluwer Health; 2015. Quadriceps and hamstrings exercises can proceed according to the patient’s comfort. Unrestricted active and passive range-of-motion exercises of the knee and hip can similarly be instituted immediately after surgery. Radiographic evaluations are usually obtained at 6 weeks, 12 weeks, and 6 months and should include two views of the entire

16. References Court-Brown CM Heckman JD McQueen MM Ricci WM Tornetta P McKee MD. Rockwood and Green's Fractures in Adults. Eighth ed. Philadelphia: Wolters Kluwer Health; 2015. Campbell’s Operative Orthopedics, 13 th edition.