Geriatric Polytrauma - ipsilateral acetabulum / femoral neck / distal femur fractures
Score and Comment on this Case
Clinical Details
Clinical and radiological findings: Patient in his 80’s presented to trauma center after being struck on the left side while driving. Resuscitated over several days in ICU, no other significant non-orthopaedic injuries and stable for operative intervention hospital day 5.
Preoperative Plan
Planning remarks:
Surgical Discussion
Operative remarks:Patient started supine on OSI flat Jackson table and ORIF intra-articular distal femur fracture via lateral parapatellar arthrotomy and lateral locking plate extended proximal to overlap anticipated arthroplasty stem but without screws yet to obstruct.
Next a Stoppa / anterior intrapelvic approach was taken via Pfannenstiel incision to reduce and stabilize both-column acetabulum fracture with screws aimed away from anticipated acetabular socket component from THA.
Next patient was transferred supine to Hana table where direct anterior approach THA was performed with multi-hole socket and lateralized / eccentric liner to restore offset given cup medialization. Stem was a polished taper-slip cemented stem given osteopenia. Finally, a screw was inserted percutaneously into most proximal hole of distal femur plate aimed anterior to hip stem to avoid stress riser. Patient will be limited weightbearing for 6-8 weeks to allow consolidation of distal femur and acetabulum.
Orthopaedic implants used: Synthes variable-angle 4.5 distal femoral locking plate, Stryker supra-pectineal acetabular plate, Stryker Trident II acetabular socket with Exeter stem
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Daniel B. Chan, MD
- United States ,
- Area of Specialty - Joint Replacement
- Position - Head of Department
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User Discussion (2)
Dr Ed Oates
Absolutely spotless. All done in one sitting? Only critical comment from my spot on the bench: I would have perhaps fixed the proximal plate differently. I would maybe leave the diaphyseal screw just proxmial to the fraxture out, and place it 2-3 holes further up to increase working length of the plate. Also would have taken the next longer plate and sent it up to the LT, with 2 screws proximal to the prosthesis. 8 cortices in total, overlapping the implant. All just gut feel, very difficult to define working length for supracondylar fractures, then throw in mixed plate function (stress riser reduction etc). Brilliant work though, very nice case!
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