# ORIF periprosthetic femur fx



## rlcohen76

question....have a case where pt had 3 previous revision surgeries including bone grafting to the proximal femur secondary to osteolysis. 
Fell recently, xrays revealed grade 1 periprosthetic femur fx.

ORIF for right open periprosthetic femur fracture. 


previous cables were removed, removed the cement mantle and recreated the femoral canal .Longitudinal traction was used to reduce the fx and an osteotome was used to control the fx and split the remainder of the anterior cortex right at the femur. A longitudinal incision mad distally about the knee, placed a 14 hole condylar locking plate on the distal femur, ran it thru the subcutaneous tissue thru the vastus lateralis to the femur. Fx was expanded by 6 cortical diameters. An anterior strut graft was placed to recreate the anterior cortex which was damaged. This was placed over the fracture site. Placed 3 Dall-Miles cables proximally in the usual fashion, k-wires on the distal end of the plate to hold it onto the femur. 3 more Dall miles cables were placed in both the proximal and distal ends of the fx. Once the fx was secure and the plate in adequate position, placed 5 screws distally and 1 screw in the metaphysis. Excellent reduction and external fixation. 
Closed the deep fascia using #1 victyl sutures, closed the vastus lateralis using more Vicryl sutures then closed the subcutaneous tissue with 2-0 vicryl sutures and skin using staples.  

27236 or 27506? we are not sure of either! thank you much.


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## PLAIDMAN

Where was the actual fx? Hip or Knee?
I am not seeing the IM Rod? 27506?
I am also not getting the ex-fix??


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## rlcohen76

no rods, only synthes condylar locking plate with Dall-Miles cables proximally and locking screws distally. 

Only internal fixation, although the report states "excellent reduction and external fixation" 

The fx is in the hip not the knee.

thank you for your help!"

I am leaning towards 27236


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## PLAIDMAN

O.K. 27236 sounds good then.

Maybe the op is a little confusing to me since I can't read it all, well, and the poor guy sounds like that hip is tore up.


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