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Orthopaedics
Femur
Built from Orthopedic Trauma Essentials
What’s inside
3 sections · 129 slides
Overview
- What this topic covers
- The map of femur trauma
Femoral shaft fractures
Nailing the long tube: route, entry point, position and reaming
- Who breaks a femoral shaft
- What treatment has to achieve
- Four ways to hold a broken femur
- Why the nail is the gold standard
- Antegrade nailing: entering from the hip
- Antegrade nail down a femoral shaft fracture
- Retrograde nailing: entering from the knee
- Retrograde nail with a lag screw at the knee
- Where retrograde nailing earns its place
- Does a retrograde nail wreck the knee?
- The real drawbacks of the retrograde route
- When not to nail from the knee
- Antegrade or retrograde: side by side
- Why the start hole decides the shape of the bone
- Pyriformis fossa entry: straight down the canal
- The price of a pyriformis entry
- More problems with the pyriformis fossa
- Trochanteric tip entry: easier and kinder
- Cautions with the trochanteric entry
- Where the retrograde nail starts
- Timing and the bottom line on nailing
- Why the patient's position is not a detail
- Supine on the fracture table
- Traction has its own casualties
- Supine on a radiolucent table
- Lateral decubitus
- Choosing a position
- What reaming actually means
- What reaming does to the bone
- The unreamed experiment
- Why reaming actually helps healing
- Reaming with less harm
- What a segmental fracture is
- The middle fragment's blood supply problem
- Why traction and plaster are not the answer
- Nailing is the gold standard here too
- Tricks to control the middle piece
- Schanz pin steadying the middle segment
- Locking, plating and what goes wrong
- The segmental goal
- A neck fracture hiding behind a shaft fracture
- Sometimes the surgeon causes it
- Why it is missed in a third of cases
- Catching the neck fracture
- Order of business
- Five construct choices
- Cephalomedullary nail holding neck and shaft together
- Cephalomedullary nail: strengths and limits
- Miss-a-nail screws
- Neck screws or a DHS with a retrograde nail
- Technical pearls for that combination
- Three constructs for a neck and shaft fracture
- When both bones get a plate
- Complications and the bottom line
Distal femur fractures
Classification, implants, open injuries, augmented constructs and the Hoffa fragment
- Distal femur fractures at a glance
- Three families of distal femur fracture
- Reading the classification as a plan
- Relevant fracture fixation strategy based on AO/OTA classification
- Type A: the retrograde nail
- What a wrong entry point does
- Fine tuning the retrograde nail
- Type A: the lateral locking plate
- The calf muscles pull the distal piece backwards
- Coronal alignment is the hard one
- Plate position traps
- Rigid or flexible: match the construct
- Type B: part of a condyle breaks off
- Type C: two jobs in one operation
- C1, C2 and C3
- Nail or plate: what the mechanics say
- When the plate has to win
- Why lateral locking plates fail
- Building a plate construct that heals
- From rigid to biological fixation
- Open distal femur fractures
- First moves
- Debridement rules
- Fix now or fix later
- The staged pathway
- The induced membrane trick
- Staged treatment of an open distal femur fracture
- Spanning external fixator with a cement spacer
- Non-union after an open fracture
- The stiff knee afterwards
- When one lateral plate is not enough
- The nail-plate construct
- Nail-plate pearls
- Dual plating
- The cost of the medial plate
- What a Hoffa fracture is
- Letenneur classification
- Why the X-ray lies
- Up to 30%
- CT is the gold standard
- Where MRI fits
- Hoffa surgery: what you are aiming for
- What drives the decision
- Reading the approach abbreviations
- Surgical approach and implant options based on fragment size and Letenneur type for medial Hoffa fractures
- Surgical approach and implant options based on fragment size and Letenneur type for lateral Hoffa fractures
- Choosing the approach
- Cannulated cancellous screws
- Buttress plating
- Fixed angle or variable angle
- Complications and the bottom line
- Take home points: the shaft
- Take home points: the distal femur
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- Orthopedic Trauma Essentials 2026