Complex femoral shaft fracture 1 Case for small

Complex femoral shaft fracture (1) Case for small group discussion: Fractures of the femur AO Trauma Advanced Principles Course

63 -year-old woman, involved in motor vehicle crash • Left 32 -C 2 closed femoral fracture • Left open IIIB calcaneal and pilon fractures • Left medial tibial plateau fracture • Left Lisfranc injury • LC 3 pelvic ring injury • LLE: decreased sensation superficial peroneal nerve S/p open fracture debridements and initial external fixation, then transferred to our hospital

Evaluation Day 3

Evaluation Day 3

Initial management and planning • Which antibiotics and for how long? • When should she be taken to the OR? • What are the injury priorities? • Has she been evaluated appropriately? Day 3

Plan for the left 32 -C 2 femoral shaft fracture • How long can the external fixator stay on? • How do you want to approach the fracture? • • OR table Positioning Implant(s) Reduction strategy Day 3

Reduction strategies Challenges • Rotation • Length • Alignment Day 6

Reduction strategies • Supine position • Radiolucent table • Both extremities prepped Proximal fracture • Open clamp reduction • Avoid segment rotation during reaming

Reduction strategies Distal fracture • Use of the external fixator pin • Get guide rod centered Day 6

Intraoperative checks • What do you need to check and why?

Postoperative images Day 6

3 months

Last visit 5 years

Summary and take-home message • Thoroughly evaluate for other injuries. • Complex femoral shaft fractures require multiple reduction techniques. • For segmental fractures, treat each fracture separately for reduction. • Use intraoperative radiographic images and clinical exam to determine appropriate length alignment and rotation. • Don’t miss an ipsilateral femoral neck fracture.