Workup for Femoral Shaft Frx

---

- See:
      - IM Nailing Technique:

  - PreOp Planning for IM Nailing:
          - Fracture Classification
          - Open Femur Frx
          - Comminuted Frx
          - Proximal Frx:
          - Distal Frx:
  - Associated Injuries:
          - Frx - Menu
          - Hip Dislocation
          - Femoral Neck Frx
          - Knee Ligament Injury
          - C-spine
          - Spine
          - Pelvis
          - Pulmonary:
                  - fat embolism syndrome:
                  - references:
                        - Early unreamed intramedullary nailing of femoral fractures is safe in patients with severe thoracic trauma.
          - Vascular Injury
          - Timing of Surgery in Orthopaedic Patients with Brain Injury

  - Systems:
          - Neuro (see Glasgow)
          - Cranio-Maxillo-Facial
          - Spine
          - Cardiac
          - Renal
          - Compartments
          - Hepatic / GI:
          - Coag
  - Checklist:
          - Consent: Open vs Closed Reduction
          - Posting
                  - Blood & Cell Saver
                  - Implant Selection (Synthes)
                  - Positioning
                  - Table type and Flouro (specify locations of each in the room)
          - Skeletal Traction
                  - skeletal traction w/ 25 lbs (or more) will bring frx out to length;
                  - generally skeletal traction is necessary w/ delayed treatment;
                  - following insertion of skeletal traction, it is necesary to document that frx is out to length w/ portable lateral radiograph;
          - Blood: 2 units
          - Prophylactic ATB
          - DVT prophylaxis
          - X-rays and Template
          - Planned Incision
          - Anesthesia & Cardiology Consults
          - Misc: antibiotic beads for open frx;

- Initial Orders:
        - NPO p Midnight x Meds
        - IVF D5W LR at 100 ml/hr (in stable patients use D5W 1/2 NS w/ 20 KCl)
        - 2 large bore IV
        - Foley
        - Monitoring;
                - EKG and/or Continuous Cardiac Monitoring;
                - Continuous Pulse Ox monitoring;
        - PreOp Labs:
                - Type & Cross 2-4 units pRBC and/or FFP
                - Musculoskeletal Labs:
                - Urinalysis
        - Meds (Trade Names)
                - Prophylactic ATB
                - DVT prophylaxis
                - Steroids:
                      - for neurological deficits
                      - for FES prophylaxis
                - Heparin 5000 units SQ q8 hrs
                - Insulin (1/2 NPH dose) + S.S. - Accu Check in AM and on call
                - Zantac
                - Morphine
                - Tetanus or Pneumovax if appropriate;
        - Traction: (Buck's vs. Skeletal)
        - Decubiti Prophylaxis:   Egg Crate / Pillow and turn 20 deg q2hr
        - Hiboclens Shower and Bactroban to nares q12 hrs until OR
        - Cleocin solution 300 mg per 100 ml NS q6hr as mouth wash





- Misc:
    - Mechanism: high energy injuries from MVA or GSW, or Pathologic frx;
          - fails in tensile strain;
          - common mech is bending Transverse frx;
          - pathologic frx are more commonly spiral after torsion strain;