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Yeah. So this is our first session about neo femur fracture and we are gonna be a few sessions after about a fracture you will face on your on call. So we start with a neo femur fracture is a day that you had that once you are on call, you will short get on uh femur fracture. So you start with a history. You should listen uh to the ed story very well. Try to ask question, try to find everything about it. A fracture, the patient and everything. So what do you want to expect to know? You expect to know the whole story about the injury and or how was the patient? So what about mobility? Why we need to know about mobility because it will affect the management later on? Ok. You should know about past medical history. Everything in the past medical history is considered as relevant. But these two species options are first thing in patient with the cancer. You should know the life expectancy from the oncology, letters from the patient himself, if he's aware or whatever, if not, we should send an email to the oncology team to asking them about that. And this and making sure that this information is available before the summer meeting. And if it's not available, we're gonna chase it until we know the information because it will affect also the management, the patient with any history of cancer, even if it is 10 years old and there is no evidence of metastasis. You will need a full femur X ray specifically if the patient on will go for any kind of osteoplasty hemi or. Ok. So cancer is done. The other thing is anticoagulation. You need to know few things about the anticoagulation. For sure why this patient is taking the anticoagulation. The other thing when was the last dose? Why? Because it will change the plan for the patient if the patient can go for the surgery on the day or on the day after. Ok, we can OK. You are going out to see the patient, you will examine the patient for sure. You need to exclude that there is no other injuries and everything. But what also be the examination you should be doing for this patient, sciatic nerve examination, sensory and motor femoral nerve examination and for short distal pulse by that, I mean, do pies and refill time. You're going to check the X ray, where is your fracture? And we're going to speak about the x-ray later on blood when you go to, I expect to send for bloods before calling me and group and safe for the patient to be ready for surgery, they need to go and safe. Ok, at least will do one. You do the second or whatever, even if sometimes recent one and uh plus are available because the patient have historical one or something. So just make sure that there is blood available for the patient. Consenting note, if the reason you can do consenting since you are comfortable with consenting, you know, the surgery and the complication and you are sure about that. You can do consenting and the we check in the morning if you are not comfortable doing so, please let us do it marking. You will enjoy putting your arm on the leg, won't you? After that, you make the admission time, hand over to the ed staff, please. Uh I'm admitting this patient at this point. After admission, you are expected to prescribe medication is a very important and it was a legal issue regarding to the in the past. So please make sure that you do have analgesia for sure. Bt reflexes is fundamental and fatal. So don't miss prescribing the test and the chemical reflexes. Usually we prescribe, you know, for patients, if you see the patient will go for surgery. Gives the mission N by mouth, I usually give him one n by mouth just in case. OK. So N femur fracture is a big classification. We will start with the first thing you should know about femur fracture. A couple of things. First thing is intracapsular or extracapsular. Why it will change your management? So you can see this green line there. It extend from the GT to the laser laser treatment. Loser is extracapsular is in capsular. OK. So let's start with extra capsule fraction. This is two big times for the extra capsule fraction enter through which extending from the GT to the li and sub tronic which is in the area which is five centimeters below is a literature. We call it a client. Why it's very crucial to classify as a fracture if it is extra capsular or intracapsular because extra capsular fracture, yeah, you're going to fix it. But intracapsular fracture most probably you want to replace it. Perfect. So intro fracture, usually we fix it with ad chest sub fracture. We usually fix it with a alone. You are familiar with these basic things. That's OK. A lot of discussion will go which is more effective, which is more suitable. I will tell you that in Southampton they never use the DS, they always use. I we discuss that here. Inter country country. OK? It's a bar inter capsular fraction. So if we speak about the capsule fracture, there is a classification called garden classification. This classification would classify the inter capsule fraction in four grades. 1234. There was a traditional song going they say 12, put a screw, 34 more. What does this mean? So one and two, you can read about gardening classification. But I will tell you always a principle. So 12 usually is a undisplaced or partial fraction. So we're gonna fix it, how we're gonna fix it. We're gonna fix it with the screws or with the DS is a, a decision. But if three or four, it means complete fracture, partial displacement or complete displacement. So we're gonna do replacement, he or two. OK. Intracapsular fracture itself can be classified into three types. The which is the is the doted line number one. On number 23, subcapital fraction. This is the most common one. You will see it a lot, but this classification is not very important. The the very important one is classification and you to decide a cation for fixation or for. So there is a guideline for the patient who had a hip fragile fracture. I just thought is the most important thing is which we need to mention. So if you go to patients refer, there's a clinic in North, you cannot see any abnormal as x-ray because quality or because there is no fracture should be book on the X ray. So the first choice for you to do first thing is to do MRI scan is within 24 hours. If the MRI scan is not available or contraindicated, we will go with CT scan for of patients. The national guideline states that they should underwent surgery if indicated within 2048 hours from the fraction postoperative, full weight bearing in enough should be able to full weight bear after the surgery unless there is a uh specific indication for not bearing from the surgery with prophylaxis. We will do a teaching video with VT Pro later on. Make sure that it's prescribed on admission, make sure that if your patient is old on VT prophylaxis is always contraindicated. So a lot of confusion between refill here and there. So what should you expect from to do for you? For enough patients? They should know the history until you they should exclude any other injuries. They should send full bloods x-ray, they should do the fib but they should doesn't guarantee that they will do it. Just check all these boxes while you are over the phone, talking to the doctor. Ok. You will ask about the history, we will check the blood, you will check the X ray and you will ask them to do the f and make sure it's safe for done. At least one should be done in there is a performer for the North. You can find it in the world about um medical issues. How do you deal with that? We will not go there right now but please find this performer. It's gonna be the big issue. How's that saying before that trauma meeting? You should have the Yeah, you should do whatever we mentioned before and be prepared to present your case. In addition, if any discussion to need need to be done with the family or something like that and you can do it, please do it if not hand over that the family is not aware and you need to speak with them. Yeah. Do you have any questions? No. Perfect. Thank you.