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.
M. Grant Liska, BS University of Central Florida College of Medicine
Asif M. Ilyas, MD, MBA, FACS Rothman Institute at Thomas Jefferson University
Dr. Asif Ilyas at the Rothman Institute presents the case of a proximal pole scaphoid fracture repaired with ORIF via a dorsal approach. After dissection through the joint capsule and exposure of the base of the scaphoid, a headless compression screw is placed anterograde in line with the thumb in all planes. This procedure provides increased stability and improved rate of the union in correlation with the accuracy of intraoperative reduction, leading to improved outcomes for surgical candidates over more conservative approaches.
In this case, Dr. Asif Ilyas at the Rothman Institute presents the case of an adult female presenting with a dorsally displaced and angulated fracture of the distal radius after a fall on the outstretched hand. The fracture was treated by open reduction and internal fixation with a volar locking plate, and the natural history, preoperative care, intraoperative technique, and postoperative considerations of distal radial fractures are outlined.
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.