Tag Archives: femur

Orthopedic Trauma, Orthopedics, Print Release

PUBLISHED: Single-Incision Retrograde SIGN Nailing of the Femur and Antegrade SIGN Nailing of the Tibia for a Delayed-Presentation Floating Knee Injury

Single-Incision Retrograde SIGN Nailing of the Femur and Antegrade SIGN Nailing of the Tibia for a Delayed-Presentation Floating Knee Injury
Donald L. Fejfar, MD1; Samhita Kadiyala, BA1; Nikhil Gattu, MD1; Emily S. Powis, BS1; Elizabeth Rich, MD2; Ridwan M. Saeed, MD3; Hizkyas Kassaye, MD4; Pierre M. Woolley, MD5; Bitiel Banda, MD6; Kiran J. Agarwal-Harding, MD, MPH7
1Harvard Global Orthopaedics Collaborative, Boston, MA
2Walter Reed National Military Medical Center, Bethesda, MD
3Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
4Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia
5Hôpital Universitaire La Paix, Port au Prince, Haiti
6Mzuzu Central Hospital, Mzuzu, Malawi
7Beth Israel Deaconess Medical Center, Boston, MA

Floating knee injury, defined as ipsilateral femoral and tibial shaft fractures, is a high-energy traumatic injury frequently seen following road traffic accidents (RTAs), which disproportionately burden low- and middle-income countries. Definitive treatment of this complex injury typically involves internal fixation, and the commonly accepted preferred method is intramedullary nailing of both fractures. This video article describes the surgical technique for managing a floating knee using retrograde Surgical Implant Generation Network (SIGN) nailing of the femur and antegrade SIGN nailing of the tibia through a single infrapatellar incision in a single anesthesia event.

The case involves a 28-year-old female patient in rural Malawi with a floating knee injury sustained in a motorbike RTA, notable for her delayed presentation of three weeks. The key procedural steps, performed under spinal anesthesia, began with a single infrapatellar incision for the subsequent retrograde nailing of the midshaft femur. Due to delayed presentation (22 days from the date of injury to the first exam in the hospital, with 2 more days before surgery) and callus formation, intraoperative fracture fragment mobilization via a second lateral incision was required before securing the femoral nail. The same infrapatellar incision was then used to perform antegrade nailing of the proximal tibial shaft fracture, which was secured after a closed reduction. This single-incision approach provides a definitive, robust fixation solution appropriate for a resource-constrained setting where challenges include delayed patient presentation and limited imaging infrastructure.

Orthopedic Trauma, Orthopedics, Print Release

PUBLISHED: Left Hip Hemiarthroplasty for Femoral Neck Fracture

Left Hip Hemiarthroplasty for Femoral Neck Fracture
Michael Akodu, MBBS; Elyse J. Berlinberg, MD; Miles Batty, MD; Michael McTague, MPH; Kiran J. Agarwal-Harding, MD, MPH
Beth Israel Deaconess Medical Center

Hip fractures are a major cause of morbidity and mortality, especially among older patients. They also account for a significant portion of healthcare spending and other non-medical costs. These fractures can be classified into various types based on the parts of the femoral head and neck affected, and fixation options are dependent on both patient and injury characteristics. In this video, Dr. Agarwal-Harding takes us through a hip hemiarthroplasty for a left femoral neck fracture, highlighting various guiding principles and surgical considerations.

Orthopedic Trauma, Orthopedics, Print Release

PUBLISHED: Closed Cephalomedullary Nailing of a Diaphyseal Femur Fracture on a Fracture Table

Closed Cephalomedullary Nailing of a Diaphyseal Femur Fracture on a Fracture Table
Sarita Jamil1; Michael J. Weaver, MD2
1University of Central Florida College of Medicine
2Brigham and Women’s Hospital

Femoral fractures typically occur in two major settings: high-energy mechanisms related to trauma and low-energy mechanisms in insufficiency fractures observed in elderly patients with osteopenia. Patients present with pain, swelling, and limited range of motion.

Intramedullary nailing is the definitive surgical treatment for femoral fractures to allow secondary healing of bone. Such a repair is performed here on a patient with a diaphyseal femoral fracture. Surgeon preference was to perform a closed cephalomedullary nailing with the patient supine on a radiolucent fracture table for traction.

Orthopedic Trauma, Orthopedics, Print Release

PUBLISHED: Closed Cephalomedullary Nail Fixation of a Reverse Oblique Subtrochanteric Femoral Fracture in the Lateral Position

Closed Cephalomedullary Nail Fixation of a Reverse Oblique Subtrochanteric Femoral Fracture in the Lateral Position
Robert W. Burk IV, MS1; Michael J. Weaver, MD2
1Lake Erie College of Osteopathic Medicine
2Brigham and Women’s Hospital

Subtrochanteric femoral fractures commonly present in two different populations under very different circumstances. The elderly are commonly affected by low-energy events, such as a simple fall to the floor, while younger populations are more likely to be involved in high-energy events such as motor vehicle accidents. The majority of elderly injuries can be attributed to fragility fractures due to loss of bone density, but it is important to note an atypical fracture pattern that is present in those who have been taking bisphosphonates.

This video demonstrates an intramedullary fixation of a reverse oblique subtrochanteric femoral fracture in the lateral position. There is a classic deformity seen in subtrochanteric fractures due to strong muscular attachments in the region. In this video, we show that while the lateral position may be more difficult for obtaining x-rays, it provides natural external forces that make reduction and fixation easier.

Orthopedic Trauma, Preprint Release

PREPRINT RELEASE: Closed Cephalomedullary Nailing of a Diaphyseal Femur Fracture on a Fracture Table

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0121-feature-imageClosed Cephalomedullary Nailing of a Diaphyseal Femur Fracture on a Fracture Table
Michael J. Weaver MD
Clinical Instructor, Harvard Medical School Dept. of Orthopaedic Surgery, Brigham and Women’s Hospital

Dr. Weaver treats a periprosthetic femur fracture with the patient positioned supine on a fracture table using a cephalomedullary nail. The fracture table provides adequate traction to assist in reduction of the fracture.