BC/68/F

• CC: L hip pain 3 weeks PTC, stepped on a wet rug slipped and fell on
• MOI: Fall her L side. Noted L sided pain and unable to ambulate
• TOI: 9am hence consult at a LH. Advised for admission and
surgery, transferred to POC due to financial
• DOI: 5/24/2023
constraints.
• POI: Laguna

No known comorbidities
Prev community ambulator
Prev smoker, prev occasional alcoholic beverage
drinker
Physical Examination
• GCS 15, stretcher borne
• L hip externally rotated, shortened, abducted
• L hip tenderness
• Limited L hip ROMs
• Able to do ankle ROMs
• LLD Right > Left ~1cm
• FDP
• CRT<2s
Assessment
• Fracture closed complete displaced pertrochanteric femur L
• AO 31A2.2
Goals
• Achieve an adequate functional reduction
• Relative Stability
• Preservation of blood supply
• Early Weight Bearing
Plan
• Closed Reduction Proximal Femoral Nailing with Lag screw and distal
locking
• Implant: Cephalomedullary Nail 200X10mm
• Position: Supine in Fracture Table
• Approach: Trochanteric Entry Point
 Patient
Positioning
Postoperative Care
• Immediate full weight bearing is permitted and encouraged.

• Active and passive range of motion is started without restrictions.

• Knee flexor, extensors, abductors and external hip rotators should not be
neglected.
• Focus on strength balance, endurance and gait.

• CPM may be used to help with ROM of knee.

• Radiographic evaluation post operatively.

• Follow up radiographs at 6 and 12 weeks.

Checklist
• [x] implant - Cephalomedullary Nail
• [x] cardio pulmonary clearance
• [x] negative RAT result
• [x] pre-operative radiographs (injury, recent)
• [x] anesthesia site inspection
• [x] surgical site inspection
• [x] signed consent for surgery
• [x] pre-operative orders, not on anticoagulants
• [x] pre-operative laboratory workup