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¿Puedes responder correctamente a esta pregunta diaria de nuestro Free QBank? …

by | 10 de Nov, 2022 | 10 comments

Can you answer this daily question from our Free QBank correctly?

A 32-year-old male sustained a left femoral shaft fracture after a boating accident. He is treated with a retrograde femoral nail with an uncomplicated postoperative course. He presents 11-months postop with persistent thigh pain that is worse with weight-bearing. His current radiographs are demonstrated in figure A. His current ESR and C-reactive protein are 12 mm/hr (reference <20 mm/hr) and 0.9 mg/dL (reference <2.5 mg/dL). What is the best treatment option for this patient? 1. Continued observations 2. Placement of an antibiotic nail 3. Nail removal with external fixator 4. Reamed exchange nailing 5. Nail removal and casting QID: 211650 **The answer will be posted in 24 hours. #ortho #orthopedicsurgery #orthopedics #orthopedicsurgeon #orthopaedics #orthopaedic #orthopedic #ortholife #orthobullets #orthoresidents #orthoresident #orthoresidency #medicalschool #medicalstudent #medstudent #doctor #physician

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¿Puedes responder correctamente a esta pregunta diaria de nuestro Free QBank? Un hombre de 32 años sufrió una fractura del eje femoral izquierdo después de un accidente de navegación. Es tratado con clavo femoral retrógrado con un postoperatorio sin complicaciones. Presenta postoperatorio de 11 meses con dolor persistente en el muslo que empeora con el soporte de peso. Sus radiografías actuales se muestran en la figura A. Su VSG y proteína C reactiva actuales son de 12 mm/h (referencia <20 mm/h) y 0,9 mg/dL (referencia <2,5 mg/dL). ¿Cuál es la mejor opción de tratamiento para este paciente? 1. Continuación de observaciones 2. Colocación de clavo antibiótico 3. Retiro de clavo con fijador externo 4. Cambio de clavo fresado 5. Retiro de clavo y yeso QID: 211650 **La respuesta se publicará en 24 horas. #orto #cirugíaortopédica #ortopedia #cirujanoortopédico #ortopedia #ortopedia #ortopedia #ortholife #orthobullets #orthresidents #orthresident #orthresidency #medicalschool #medicalstudent #medstudent #doctor #medical

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10 Comments

  1. Eli W. Bunzel, MD

    The textbook answer is 4 but I would say before exchange nailing, a CT and nutrition/endocrine labs should be ordered for full evaluation of the etiology and character of the non-union.

    Reply
  2. T e b o g o     D i k g a l e

    4. It’s a hypertrophic non-union so the issue is stability, exchange with bigger size(diameter)nail

    Reply
  3. Fabio Sammartino

    The problem is: why the nail wasn’t blocked distally? The answer is 4

    Reply
  4. Mohsin Javaid

    4 exchange nail, with bigger nail diameter

    Reply
  5. Orthobullets

    The preferred response is:

    4. Reamed exchange nailing

    The patient is presenting with an aseptic hypertrophic nonunion that is amenable to a reamed exchange nail.

    Femoral shaft fractures typically occur after a high-energy mechanism. Reamed, locked intramedullary nailing has a high reported union rate (>95%). Nonunion is defined as the failure to heal 9 months from the index operation or no healing progression in 3 months of follow-up radiographs. Evaluation of nonunions requires evaluation for infectious or metabolic etiologies including WBC count, ESR, CRP, vitamin D, calcium, thyroid hormones, parathyroid hormone, and sex hormones. Intraoperative cultures may be of further use for detecting occult septic nonunions. Treatment options include reamed exchange nailing, compression plating with bone graft, and nail retention with plate augmentation. In this case, with a hypertrophic nonunion with an undersized nail, a reamed exchange nailing procedure could be recommended. Reaming is thought to stimulate the fracture site and provide localized bone grafting and angiogenesis – reaming also allows for placement of a larger nail that can improve the relative stability of the construct. Compression plating and bone grafting or augmentative plating are options if reamed exchange nailing is unsuccessful.

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