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Re: R HIP / FEMUR FX + L FEMUR FX
Chip Routt 02 Февраль 2007, 00:32
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Timing- now for the right, and now for the left if he remains well after the right is completed.
Sequence Right neck, right shaft, then left shaft.
2 positions 2 drapes/preps, rolled oblique for both.
Implants plenty of opinions exist for the right side...some would use neck screws anteriorly after reduction, then with a slender reamed locked nail
pushed in behind the neck screws for the shaft... some will advocate a recon nail for both...some will use a sliding screw for the neck then a retrograde shaft nail...some would use the sliding neck screw and a shaft plate also...lots of options.
I prefer excellent neck reduction either closed or open, screws high and low anteriorly for it, then a frail locked nail slipped in behind the neck screws for the shaft.
Some will also advocate hip capsulotomy as well to relieve capsular pressure related issues... it¹s done when you choose ORIF of the neck.
The left shaft fracture should accommodate an antegrade reamed locked nail after reduction, unless I¹ve missed some detail on the films as shown.
I¹d use 2 preps and drapes and assure that he¹s well after the right side before rolling on to the left.
Easy on the reaming-
Chip
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