1st Edition

Curbside Consultation in Fracture Management 49 Clinical Questions

By Walter Virkus Copyright 2008

    Are you looking for concise, practical answers to those questions that are often left unanswered by traditional fracture management references? Are you seeking brief, evidence-based advice for complicated cases or controversial decisions? Curbside Consultation in Fracture Management: 49 Clinical Questions provides quick answers to the thorny questions most commonly posed during a “curbside consultation” between orthopedic surgical colleagues.

    Dr. Walter Virkus has designed this unique reference which offers expert advice, preferences, and opinions on tough clinical questions commonly associated with fracture management. The unique Q&A format provides quick access to current information related to fracture management with the simplicity of a conversation between two colleagues. Numerous images, diagrams, and references are included to enhance the text and to illustrate the management of fractures.

    Curbside Consultation Fracture Management: 49 Clinical Questions provides information basic enough for residents while also incorporating expert advice that even high-volume clinicians will appreciate. Practicing orthopedists, orthopedic residents, and non-physician personnel will benefit from the user-friendly and casual format and the expert advice contained within.

    Some of the questions that are answered:
    • There is a patient in the ER with a femur fracture and humeral shaft fracture. Should I fix the humerus with a nail or a plate?
    • How do you decide which pelvis fractures need surgery?
    • What is your choice for a displaced femoral neck fracture in a 65-year-old: ORIF, hemiarthroplasty, or total hip arthroplasty?
    • I have a 45 Year-old woman with a bicondylar tibial plateau fracture. What type of fixation should I use?
    • I have a 38 Year-old woman with a distal tibia spiral fracture. Should I try to nail this or just plate it?
    • When do you use locking plates?





    About the Editor

    Contributing Authors


    Foreword by David L. Helfet, MD


    Question 1 I Have a 50-Year-Old Male With a Surgical Neck Humerus Fracture

    in His Dominant Arm. Should I Operate on Him?

    James Kapotas, MD

    Question 2 What Approach Should I Use for Plating a Humeral Shaft Fracture

    in a Multiple Trauma Patient?

    Adam J. Starr, MD

    Question 3 How Would You Manage a Radial Nerve Palsy Associated With

    a Humeral Shaft Fracture in the Dominant Arm of a 25-Year-Old?

    Laura Prokuski, MD

    Question 4 On Which Clavicle Fractures Do You Operate?

    Brian D. Solberg, MD

    Question 5 What Is Your Postoperative and Rehabilitative Protocol for

    Distal Humeral Fractures?

    Amon T. Ferry, MD and Mark S. Cohen, MD

    Question 6 I Have a 4-Year-Old Who Fell Off the Monkey Bars With a Swollen

    Elbow and a Fat Pad Sign. If the X-Rays Are Normal, Is Additional

    Evaluation Needed?

    Monica Kogan, MD

    Question 7 How Do You Perform a Fasciotomy of the Forearm?

    Rachel S. Rohde, MD

    Question 8 Cast, External Fixator, or Open Reduction and Internal Fixation

    for a Nonarticular Distal Radius Fracture in a 60-Year-Old Female?

    John J. Fernandez, MD, FAAOS

    Question 9 When Do You Replace the Radial Head?

    Mark S. Cohen, MD and Robert W. Wysocki, MD

    Question 10 There Is a Patient in the ER With a Femur Fracture and Humeral

    Shaft Fracture. Should I Fix the Humerus With a Nail or a Plate?

    Timothy Bhattacharyya, MD

    Question 11 I Have a 30-Year-Old Patient Who Had a Posterolateral Dislocation

    of the Elbow. How Would You Treat Him?

    Michael J. Medvecky, MD


    Question 12 My Patient is 8 Years Old and Had a Salter-Harris III Fracture

    of the Distal Femur. How Long Should I Follow Him for Growth


    Andrea S. Kramer, MD

    Question 13 What Is Your Initial Evaluation of Pelvic Fractures?

    Andrew J. Furey, MSc, MD, FRCSC and Robert V. O\u2019Toole, MD

    Question 14 Which Pelvic Fractures Are Life-Threatening?

    Andrew R. Burgess, MD

    Question 15 How Do You Decide Which Pelvic Fractures Need Surgery?

    Scott A. Adams, MD, FRCS and Steven J. Morgan, MD, FACS

    Question 16 I Have a 40-Year-Old With an Anterior Fracture of the Femoral Head

    and Incongruity of the Hip Joint. How Would You Treat This?

    Clifford Turen, MD and Andrew J. Furey, MSc, MD, FRCSC

    Question 17 I Have a 26-Year-Old in the ER With a Displaced Femoral Neck

    Fracture. Do I Need to Perform an Open Reduction and


    Robert E. Blease, MD and Peter J. Nowotarski, MD

    Question 18 What Is Your Choice for a Displaced Femoral Neck Fracture in a

    65-Year-Old: ORIF, Hemiarthroplasty, or Total Hip Arthroplasty?

    Matthew L. Jimenez, MD

    Question 19 How Would You Treat a Varus Femoral Neck Nonunion in a


    Michael Garcia, MD and Michael D. Stover, MD

    Question 20 What Is Your Postoperative Management of Hip Fractures

    in the Elderly?

    Daniel K. Laino, MD and Kenneth A. Egol, MD

    Question 21 How Would You Treat a Femur Fracture in a 6-Year-Old?

    Pradeep Kodali, MD; John F. Sarwark, MD; and Najeeb Khan, MD

    Question 22 How Would You Treat a Femur Fracture in a 12-Year-Old?

    Najeeb Khan, MD; Pradeep Kodali, MD; and John F. Sarwark, MD

    Question 23 I Have a 38-Year-Old With a Femoral Shaft Fracture Treated

    With an Antegrade Nail With No Evidence of Healing 8 Weeks

    Postop. What Should I Do?

    Bradley R. Merk, MD

    Question 24 What Is the Best Technique for Nailing a Femoral Shaft Fracture

    in a 28-Year-Old?

    Michael T. Archdeacon, MD, MSE

    Question 25 I Have a Tough Time With Subtrochanteric Fractures. Any Tricks?

    Walter W. Virkus, MD

    Question 26 When Do You Use a Spanning Fixator Across the Knee?

    Anthony T. Sorkin, MD

    Question 27 What Is Your Postoperative Management of Patellar Fractures?

    Gerald J. Lang, MD

    Question 28 What Is Your Postoperative Management of Tibial Plateau


    George Partal, MD and Marcus F. Sciadini, MD

    Question 29 I Have a 45-Year-Old Female With a Bicondylar Tibial Plateau

    Fracture. What Type of Fixation Should I Use?

    Edward A. Perez, MD

    Question 30 What Is Your Criteria for Compartment Syndrome in the Tibia?

    James Kapotas, MD

    Question 31 What Are Your Tricks for Nailing Proximal and Distal Tibial


    Walter W. Virkus, MD and Ishaq Syed, MD

    Question 32 I Have a 38-Year-Old Female With a Distal Tibia Spiral Fracture.

    Should I Try to Nail This or Just Plate It?

    Heather A. Vallier, MD

    Question 33 What Is Your Preoperative Management of a Bad Pilon Fracture?

    Cory Collinge, MD

    Question 34 How Do You Decide Which Surgical Approach to Use for Pilon


    Jeffrey M. Smith, MD and Anthony G. Sanzone, MD

    Question 35 Do You Take Out Syndesmotic Screws in Adult Patients?

    Joseph D. DiCicco, DO; Micah C. Hobbs, DO; and Matthew W. Heckler, DO

    Question 36 I Have a Male Patient With a Trimalleolar Fracture, But the Posterior

    Malleolus Is Minimally Displaced. Do I Need to Fix It?

    Rajeev Garapati, MD

    Question 37 What Is Your Postoperative Protocol for Bimalleolar Ankle Fractures?

    Rajeev Garapati, MD

    Question 38 I Have an Insulin-Dependent 52-Year-Old Female With a Minimally

    Displaced Bimalleolar Ankle Fracture. Should I Treat Her in a Cast?

    Simon Lee, MD

    Question 39 On Which Calcaneal Fractures Do You Operate?

    Robert Vander Griend, MD

    Question 40 There Is a Patient in the ER With a Displaced Talar Neck Fracture.

    What Is the Technique for Fixation?

    Armen S. Kelikian, MD

    Question 41 Which Metatarsal Fractures Need Surgery?

    Johnny L. Lin, MD

    Question 42 Do You Ever Bone Graft Acute Fractures?

    Dave Dean, DO and Bruce H. Ziran, MD

    Question 43 I Have a 34-Year-Old Male With a Nonunion of a Plated Midshaft

    Tibia Fracture. How Do You Approach This Problem?

    Stuart M. Gold, MD

    Question 44 How Do I Treat a Child With a Twisted Ankle and Normal X-Rays?

    Monica Kogan, MD

    Question 45 How Do You Assess Compartment Syndrome of the Foot?

    Johnny L. Lin, MD


    Question 46 I Have a 38-Year-Old Male in an MVC With Multiple Orthopedic

    Injuries. Should I Fix Everything Now or Do Damage Control


    Jason W. Nascone, MD and John C. P. Floyd, MD

    Question 47 Do Bone Stimulators Work on Nonunions?

    Blane Sessions, MD and Craig Castleman Greene, MD

    Question 48 When Do You Use Locking Plates?

    Thomas F. Higgins, MD

    Question 49 Which Fractures Require Anatomic Reduction?

    Medardo Marota, MD and Walter W. Virkus, MD




    Walter W. Virkus, MD is an Associate Professor of Orthopaedic Surgery at Rush University Medical Center in Chicago, IL. His practice focuses on orthopedic trauma and orthopedic oncology. He did his residency at the University of Maryland, and trauma fellowships at Shock Trauma in Baltimore, MD and the Hospital for Special Surgery in New York, NY. He then did an oncology fellowship at the University of Florida.

    Dr. Virkus is active in research with a special interest in applying trauma techniques to limb preservation in oncology patients. He is very active in resident education and serves as the Associate Program Director for the Rush Orthopaedic Residency.

    “This format is refreshing and allows residents, fellows, and orthopedic surgeons the same access to the experts as they would get when walking rounds or in the hallway of a major meeting. This book is a comfortable efficient read that addresses common questions and current state of the art. Each case is presented in an easy to read conversational manner that makes getting through the entire 200 pages easy and pleasurable. This volume on fracture management is wonderful addition to the series. This format is a refreshing way to learn and keep up with the most current concepts and approaches to problems as guided by leading experts in the field. It’s a great new way to feel like you just walked on rounds with your mentor and had the privilege of getting an expert opinion about 49 issues in fracture care.”  

    - Mark R. Hutchinson, MD, University of Illinois at Chicago College of Medicine, Doody Enterprises, Inc.