1. Complex femoral shaft fracture (2)
Case for small group discussion: Fractures of the femur
Fred Baumgaertel, DE
Discussion points for this case:
Type of injury with regard to severity and energy absorbed
Classification
Initial treatment, damage control
Reduction techniques
Stabilty requirements—absolute, relative
ORIF priorities—timing, implants with regard to bone segment
AO Trauma Advanced Principles Course

2. Case description 35-year-old man MVA, 80mph Dashboard
Further injuries: pelvic ring, tibia
Vital signs in ER stable

3. Serial fractures lower extremity
Pertrochanteric fracture
Multifragmentary midshaft fracture
Simple distal metaphyseal fracture
Classification?
Optional x-rays? What is missimg?
Initial treatment in ER?
What difficulties can be expected?
What is the first step?
Fracture priorities?
Appraoch to proximal femur, is the fracture stable? Implant choice?

4. Principle: relative stability Method: splinting Technique: nail
Discussion points:
Choice of implant, alternatives?
Has the implant been applied correctly?
What complications can be expected?

5. Multifragmentary shaft fracture Principle: relative stability Method: splinting Technique: MIPO
Discussion points:
What is injury to the metaphysis?
Classification?
What role does damage control orthopedics play here?
Position of external fixator?
Approach to distal femur?
Alternative internal fixations?

6. Postoperative X-rays Discussion points: Reduction technique required?
Biomechanical properties of plate adequate?
Fracture healing expected?
Complications expected?

7. 16 weeks Lateral neck, multifragmentary shaft, split condyle
Outcome of proximal pertrochanteric fracture?
Lateral neck, multifragmentary shaft, split condyle

8. Take-home message Complete picture of injury is important for planning
Damage control may be part of initial procedure
Combined internal-external fixation can be beneficial for complex femoral fractures involving entire bone
Balance of biology and mechanics requires planning with alternatives incorporated
Moderator should ask participants to summarize what else they have learned from this case.