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Pertrochanteric fracture

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Presentation on theme: "Pertrochanteric fracture"— Presentation transcript:

1 Pertrochanteric fracture
Case for small group discussion: Management principles for the treatment of articular fractures Hiroaki Minehara, JP Discussion points: Differentiate between high-energy and low-energy injury Fracture classification (stable/unstable fracture) Tip-apex distance Pros and cons of DHS vs IM device Timing of surgery Entry point vs type of nail Preoperative planning/nail length Patient positioning Fracture reduction Intraoperative imaging and assessment of reduction Aftertreatment AO Trauma Advanced Principles Course

2 74-year-old woman, fall from a 3-meter height
Vital sign stable Closed Associated injuries: Stable pelvic ring fracture, left blow-out fracture, zygomatic fracture Discussion points: How do you classify this fracture? Is this a stable or unstable fracture? Is further imaging required: CT scan, better x-rays? What would be your initial management? Day 0

3 Other X-rays and CT Discussion points:
Discuss operative management: DHS vs IM device. When is the best timing of surgery? How to manage the pelvic fracture? Try to prioritize. Any comments on initial management in this highly displaced fracture? What would your reduction strategy be?

4 Operative reduction technique
Schanz screw used as a joystick to control the fragment Discussion points: Other reduction techniques?

5 Discussion points: Nail entry point Position of the implant in the femoral head (tip-apex distance) Acceptable reduction? Aftertreatment

6 1 month postoperative

7 1 year postoperative

8 Summary and take-home message
Immediate operative treatment should be considered for an unstable proximal femoral fracture if the status of the patient allows. Intramedullary nailing is the treatment of choice for unstable proximal femoral fractures. Good fracture reduction is very important and can be obtained by using non invasive operative reduction techniques. Fracture reduction starts in the emergency room! Moderator should ask participants to summarize what else they have learned from this case.


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