Free CME

Join now

CASE REPORT

Orthopaedic Surgeon - Trauma Specialty

OhioHealth Grant Medical Center

Cleveland Clinic, Ohio

6

(P: 214966) If you choose Fracture reduction internal fixation (FIX), what Reduction technique would you use?

I would not choose Fracture reduction internal fixation (FIX)

0%

0/391

Closed Reduction - Fluoro + Fx Table

68%

269/391

Closed Reduction - Percutaneous K-wires (joystick technique)

13%

54/391

Open Reduction - Watson Jones Approach

2%

11/391

Open Reduction - Direct Anterior Approach

0%

3/391

Open Reduction - Direct Lateral Approach

11%

46/391

Outside my area of expertise - best if I don't vote

2%

8/391

I would treat this with a recon nail, using supine positioning on a traction table. I would be prepared for the proximal segment to misbehave, require additional reduction maneuvers, and provisional fixation.

Looks nicely reduced and the nail is good proximally. In my opinion, it could be a length or two longer and for me personally an integrated two screw design is better but that’s totally subjective.

straight, smaller diameter reconstruction style nail. Less abductor violation, on axis and straight won’t malreduce or wedge the fx on insertion, smaller proximal body to insert in hard, young bone. Don’t need controlled collapse here, we’re going for locked in anatomic reduction

what reduction clamps are you using in this case if you needed to open reduce? I find you need multiple clamps to correct all planes

I like to use a large steam pen in the proximal fragment to make sure I get the varus completely resolved if not a bit of valgus. I agree with using at least a trochaformis point if not pure pitiformis, even if you’re using a CMN