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David B. Weiss, MD Division Head Orthopaedic Trauma University of Virginia Disclosures In your program University of Virginia Orthopaedic Surgery Motocross Big Air Land Hard University of Virginia

  1. David B. Weiss, MD Division Head Orthopaedic Trauma University of Virginia

  2. Disclosures • In your program University of Virginia Orthopaedic Surgery

  3. Motocross Big Air… Land Hard University of Virginia Orthopaedic Surgery

  4. You are on call • And it’s Christmas Eve • What should you do? • Fix? – When? • Replace? • Transfer? • Phone a Friend? University of Virginia Orthopaedic Surgery

  5. Injury Films University of Virginia Orthopaedic Surgery

  6. Selected CT cuts Typical Deformity- Anterior tension failure with posterior comminution University of Virginia Orthopaedic Surgery

  7. Selected CT cut University of Virginia Orthopaedic Surgery

  8. Classification • Pauwel’s – Based on verticality of fracture line through neck – Shearing forces increase as type does University of Virginia Orthopaedic Surgery

  9. So Now What? • Isolated injury • Now 8 pm? • Send out an SOH….. University of Virginia Orthopaedic Surgery

  10. ORIF SOH ….Save Our Hip University of Virginia Orthopaedic Surgery

  11. Tactic • Anterior Smith Petersen approach – Better visualization of neck vs. Watson Jones • Small mini fragment plate for temporary reduction (leave in place) • Horizontal lag screw 1st • Fully threaded screw last to strut against varus • Screws placed through accessory lateral incision University of Virginia Orthopaedic Surgery

  12. Other Fixation Options • Sliding Hip screw • Proximal femoral locking plate • Blade plate (technically challenging) • How much head left for fixation? (Know your implant) University of Virginia Orthopaedic Surgery

  13. Proximal Femoral Locking Plate University of Virginia Orthopaedic Surgery

  14. Post Op- 6 weeks University of Virginia Orthopaedic Surgery

  15. 13 mos post op Persistent Lucency posteriorly Mild varus University of Virginia Orthopaedic Surgery

  16. 15 mos post injury Valgus IT osteotomy University of Virginia Orthopaedic Surgery

  17. 6 Yrs post injury Minimal Pain Works manual labor job Minimal Shortening University of Virginia Orthopaedic Surgery

  18. Literature • Early literature advocated immediate ORIF within 8hrs • Not been reproduced • Current Opinion is obtain anatomic reduction in timely fashion (wait for right team to be in place) but goal is < 24 hrs University of Virginia Orthopaedic Surgery

  19. Summary • Challenging cases • Do not have to be done middle of night but should be accomplished expeditiously • Need to be followed for 18+ months • Valgus IT osteotomy is good bailout for nonunion • Know your limitations- refer to specialist if needed University of Virginia Orthopaedic Surgery

  20. Questions/Discussion University of Virginia Orthopaedic Surgery

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