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[1/5] Distal femur periprosthetic fracture. You’d be hard pressed to find someone who wouldn’t operate on this. However, I’ve seen non-ambulators with this shear pattern treated nonop & then that proximal medial fragment slowly comes out of the skin and becomes an open fx—beware!
![[1/5] Distal femur periprosthetic fracture. You’d be hard pressed to find someone who wouldn’t operate on this. However, I’ve seen non-ambulators with this shear pattern treated nonop & then that proximal medial fragment slowly comes out of the skin and becomes an open fx—beware!](https://pbs.twimg.com/media/EtUDlhZXEAEt4fJ.jpg "[1/5] Distal femur periprosthetic fracture. You’d be hard pressed to find someone who wouldn’t operate on this. However, I’ve seen non-ambulators with this shear pattern treated nonop & then that proximal medial fragment slowly comes out of the skin and becomes an open fx—beware!")
[2/5] From my prior years of being “alone” (no residents) I like to make life easier for myself so this was automatic small incision & clamp. I use fluoro heavily to help me with incision planning, so here I am drawing lines along freer to place my incision in the best position.
![[2/5] From my prior years of being “alone” (no residents) I like to make life easier for myself so this was automatic small incision & clamp. I use fluoro heavily to help me with incision planning, so here I am drawing lines along freer to place my incision in the best position.](https://pbs.twimg.com/media/EtUDl5yXEAExNQi.jpg "[2/5] From my prior years of being “alone” (no residents) I like to make life easier for myself so this was automatic small incision & clamp. I use fluoro heavily to help me with incision planning, so here I am drawing lines along freer to place my incision in the best position.")
![[2/5] From my prior years of being “alone” (no residents) I like to make life easier for myself so this was automatic small incision & clamp. I use fluoro heavily to help me with incision planning, so here I am drawing lines along freer to place my incision in the best position.](https://pbs.twimg.com/media/EtUDl7oWQAA_j2S.jpg "[2/5] From my prior years of being “alone” (no residents) I like to make life easier for myself so this was automatic small incision & clamp. I use fluoro heavily to help me with incision planning, so here I am drawing lines along freer to place my incision in the best position.")
[3/5] Here is the Synthes colinear clamp reducing the fracture. Length was achieved by my resident pulling on the leg, and I got the correct rotation by putting my finger through the incision on the anterior femur, feeling the stepoff, and rotating the leg until it felt “right.”
![[3/5] Here is the Synthes colinear clamp reducing the fracture. Length was achieved by my resident pulling on the leg, and I got the correct rotation by putting my finger through the incision on the anterior femur, feeling the stepoff, and rotating the leg until it felt “right.”](https://pbs.twimg.com/media/EtUDmSGXYAMNCyi.jpg "[3/5] Here is the Synthes colinear clamp reducing the fracture. Length was achieved by my resident pulling on the leg, and I got the correct rotation by putting my finger through the incision on the anterior femur, feeling the stepoff, and rotating the leg until it felt “right.”")
![[3/5] Here is the Synthes colinear clamp reducing the fracture. Length was achieved by my resident pulling on the leg, and I got the correct rotation by putting my finger through the incision on the anterior femur, feeling the stepoff, and rotating the leg until it felt “right.”](https://pbs.twimg.com/media/EtUDmT8XIAAeKJ9.jpg "[3/5] Here is the Synthes colinear clamp reducing the fracture. Length was achieved by my resident pulling on the leg, and I got the correct rotation by putting my finger through the incision on the anterior femur, feeling the stepoff, and rotating the leg until it felt “right.”")
[4/5] Clamp then stayed on the entire time and retrograde nail went in. Here I am forced into posterior starting point which I knew would give me a slight malreduction problem in the end; I aimed to minimize that by keeping the clamp on until nail was locked proximal and distal.
![[4/5] Clamp then stayed on the entire time and retrograde nail went in. Here I am forced into posterior starting point which I knew would give me a slight malreduction problem in the end; I aimed to minimize that by keeping the clamp on until nail was locked proximal and distal.](https://pbs.twimg.com/media/EtUDmpGWYAA1UAM.jpg "[4/5] Clamp then stayed on the entire time and retrograde nail went in. Here I am forced into posterior starting point which I knew would give me a slight malreduction problem in the end; I aimed to minimize that by keeping the clamp on until nail was locked proximal and distal.")
![[4/5] Clamp then stayed on the entire time and retrograde nail went in. Here I am forced into posterior starting point which I knew would give me a slight malreduction problem in the end; I aimed to minimize that by keeping the clamp on until nail was locked proximal and distal.](https://pbs.twimg.com/media/EtUDmrIXUAMWCPD.jpg "[4/5] Clamp then stayed on the entire time and retrograde nail went in. Here I am forced into posterior starting point which I knew would give me a slight malreduction problem in the end; I aimed to minimize that by keeping the clamp on until nail was locked proximal and distal.")
![[4/5] Clamp then stayed on the entire time and retrograde nail went in. Here I am forced into posterior starting point which I knew would give me a slight malreduction problem in the end; I aimed to minimize that by keeping the clamp on until nail was locked proximal and distal.](https://pbs.twimg.com/media/EtUDmsdXEAMrbmy.jpg "[4/5] Clamp then stayed on the entire time and retrograde nail went in. Here I am forced into posterior starting point which I knew would give me a slight malreduction problem in the end; I aimed to minimize that by keeping the clamp on until nail was locked proximal and distal.")
![[4/5] Clamp then stayed on the entire time and retrograde nail went in. Here I am forced into posterior starting point which I knew would give me a slight malreduction problem in the end; I aimed to minimize that by keeping the clamp on until nail was locked proximal and distal.](https://pbs.twimg.com/media/EtUDmuKXIAMOvZu.jpg "[4/5] Clamp then stayed on the entire time and retrograde nail went in. Here I am forced into posterior starting point which I knew would give me a slight malreduction problem in the end; I aimed to minimize that by keeping the clamp on until nail was locked proximal and distal.")
[5/5] Finals. Looks great on AP, but on lateral we still ended up with a little malreduction because starting point limited. But bone was good and 3 screws in distally, so I was not concerned. If you want a paper about which knees have a posterior start: https://pubmed.ncbi.nlm.nih.gov/24929282/
![[5/5] Finals. Looks great on AP, but on lateral we still ended up with a little malreduction because starting point limited. But bone was good and 3 screws in distally, so I was not concerned. If you want a paper about which knees have a posterior start: https://pubmed.ncbi.nlm.nih.gov/24929282/](https://pbs.twimg.com/media/EtUDnIaXMAIlBmD.jpg "[5/5] Finals. Looks great on AP, but on lateral we still ended up with a little malreduction because starting point limited. But bone was good and 3 screws in distally, so I was not concerned. If you want a paper about which knees have a posterior start: https://pubmed.ncbi.nlm.nih.gov/24929282/")
![[5/5] Finals. Looks great on AP, but on lateral we still ended up with a little malreduction because starting point limited. But bone was good and 3 screws in distally, so I was not concerned. If you want a paper about which knees have a posterior start: https://pubmed.ncbi.nlm.nih.gov/24929282/](https://pbs.twimg.com/media/EtUDnHIWgAcr4P4.jpg "[5/5] Finals. Looks great on AP, but on lateral we still ended up with a little malreduction because starting point limited. But bone was good and 3 screws in distally, so I was not concerned. If you want a paper about which knees have a posterior start: https://pubmed.ncbi.nlm.nih.gov/24929282/")
![[5/5] Finals. Looks great on AP, but on lateral we still ended up with a little malreduction because starting point limited. But bone was good and 3 screws in distally, so I was not concerned. If you want a paper about which knees have a posterior start: https://pubmed.ncbi.nlm.nih.gov/24929282/](https://pbs.twimg.com/media/EtUDnKCXYAM7HDo.jpg "[5/5] Finals. Looks great on AP, but on lateral we still ended up with a little malreduction because starting point limited. But bone was good and 3 screws in distally, so I was not concerned. If you want a paper about which knees have a posterior start: https://pubmed.ncbi.nlm.nih.gov/24929282/")
