Subtrochanteric Femur Fractures: 5 Tips in 5 Minutes Bob Zura. MD LSU New Orleans OSET 2017 Las Vegas
Disclosures • Consultant: – Smith-Nephew – Bioventus – Cardinal Health
Subtrochanteric Femur Fractures • Fractures within 5cm of lesser trochanter • Bimodal – Young – high energy – Elderly – low energy and periprosthetic
Deformity • Muscular Attachments – Inbalance after injury causes deformity – Proximal: • Iliopsoas flexion and external rotation • Short abductors - abduction – Distal: • Adductor magnus
Surgery • This is easy – 1. Reduce the fracture – 2. Apply an appropriate implant • Occasionally, these 2 events occur concurrently
But you must…… REDUCE THE FRACTURE!
Tip #1: Go Lateral • Easier to reduce • Easier to Nail • Easier to open • Better for Fatties
Tip #2: Nail When you can • Nails are just Better
Method of Reduction - Nail • Küntscher Technique: – to reduce proximal femoral fractures. The olive-tipped guidewire can be passed through the repositioning equipment to the distal fragment. •Rockwood and Green
But…nails are not always so easy
Tip #3: The Right Starting Point!
Nail - Starting Point • Tip of the Trochanter – Avoid varus! – In line with posterior cortex on lateral – Helps correct flexion – Not too anterior • Avoid blowout • Piriformis is still allowed too!!!
Starting Point • Critical because you do not want……
Extension
Varus
Comminution
Tip #4: Use Tricks to Reduce
Retained plate
Tip#5: Revise with the Opposite • If bad plate – use Nail • If bad Nail – use plate
To assist with Complications • 38 yo healthy contractor • 6’3”, 250 lbs • Injured skiing
• Treated with OIF locally
•Bonus Tip 5.5: •DON’T TRUST YOUR FLUORO
4 year follow-up
Bonus Tip Tip#6: Don’t forget the Blade!
Tip #4 in action!
These are very hard fractures!!! GOOD LUCK!
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