a 46 years old patient with ipsilateral neck femur and distal end radius fracture, the aim of this lecture is to highlight the deficit of evidence base or literature for such combined cases and to stimulate orthopedic surgeons in reporting how did they manage their cases. #dr_azanki

1. Clinical Meeting
Presented by :
Mohamed Hossam Alakhder
Orthopedic Surgery Resident (R2)
Abdallah Jomaa El Azanki
Clinical Fellow
Orthopedic Surgery As. Lecturer
Cedar Tree
of Lebanon
Neck of Femur + Distal Radius Fracture

2.  Date of injury: 4/12/2018 at 10
am
 Date of admission: 4/12/2018
at 6 pm
 Date of surgery: 6/12/2018
• 46 years old
• Male

3.  Present / Past History :
 Driver
 Medically free
 FFH (15m), direct ally (RT side)
 Complaints:
 Pain RT wrist
RT Hip ( WB inability )
 Investigation :
 HG :13
 PLT :297,00 ,
 Renal &Liver fnx -- NAD
 INR:1.3

4.  General :
 Oriented
 Cooperative
 Local :
 Tenderness over Rt hip & ext. Rotation
 Swollen & tender Rt wrist
 Neurovascular examination:
NV free
Clinical Examination

6. Pauwel’s Type 3

7.  NOF fracture CEMNETLESS BIPOLAR
 DER BEC ( CONS )
 Start Rehabilitation Of Hemiarthroplasty By
Early Weight Bearing with the Aid Of Four
Crutches walker.

10. Start of the Evidence Based Session

11. Step by Step Evidence Based
Correlations

12. NOF Fracture
Fixation Arthroplasty
DER Fracture
Fixation Short Arm Cast
Hemi-
arthoplasty
THA
MCS
DHS +ARS
Dorsal Plating
Volar Plating
But what’s about having both in one young patient !!!!
Pinning
OSTEOPOROSIS !!!!!!!!

13. NOF Fracture TX URGENCY

14. NOF Fracture Tx URGENCY

15. 2014 changing Concepts on NOF TX ?!

16. NOF Fracture Treatment Options

17. NOF Fracture in Young Adults
The 60% failure story

18. NOF Fracture Fixation… MCS, PFN or DHS ?!

19. NOF Fracture Fixation with MCS anchored
with bone cement

21. AVN after NOF Fracture Fixation in
Young Patients

22. Arthroplasty for NOF Fracture

23. THA for NOF Fracture !!! But in elderly

24. THA for NOF Fracture in Young Ptn too!!

25. Cemented or uncemented THA ?!

26. WB in unCemented implant?!

27. Hip Hemiarthroplasty:
 Avoid Posterior approach
 Uni/Bipolar are the same
 Cemnted stems
 Staples are faster & same
in infection

28. DER Tx Guidelines

29. DER Plating, Dorsal or Volar?!

30. Can Plating Withstand Crutches aided
walk stresses?!

37.  No evidence based answer for
treatment of both NOF and DER
fracture at once .
 Each got a separate
Rehabilitation support but no
combination present for both.

38. Dessert

39. Hope You Enjoyed it !!
#dr_azanki