Executive Editor: Chris Colton

Authors: Peter V Giannoudis, Hans Christoph Pape, Michael Schütz

Femur shaft

back to skeleton

Glossary

Basic treatment techniques

Femur shaft fracture management with minimal resources
Reduction and traction techniques with limited facilities
Basic technique: Modular external fixation

Surgical procedures sorted by fracture type

Use this menu to jump directly into a specific classification (optional):
A1 A2 A3 B1 B2 B3 C1 C2 C3
A1

Simple spiral fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Temporary Thomas splint Medically unfit for surgery. Usually temporary Basic surgical experience, no specialized skills Basic equipment only
External fixator (midshaft/distal shaft) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
External fixator (subtrochanteric) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing (subtrochanteric) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Antegrade nailing (midshaft/distal shaft) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing (midshaft/distal shaft) Closed fractures, Gustilo types I & II open fractures, stable polytrauma. “Floating knee” injury, bilateral lower extremity fractures. Pregnancy. Obesity. Ipsilateral femoral neck and shaft fractures. Concomitant ipsilateral acetabular / pelvic ring fractures. Fracture below hip prosthesis. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Compression plating - DCS (subtrochanteric) Failed indirect reduction, polytrauma with chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Compression plating - locking plate (subtrochanteric) Failed indirect reduction, polytrauma with chest injury, early pregnancy, image intensification not available Some specialized surgical experience Simple surgical and imaging resources
Compression plating - DCS (distal shaft) Failed indirect reduction, polytrauma with chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Lag screw with protection plate (midshaft) Failed indirect reduction, polytrauma with chest injury, early pregnancy, image intensification not available Highly experienced and skilled surgeon Simple surgical and imaging resources
A2

Simple oblique fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Temporary Thomas splint Medically unfit for surgery. Usually temporary Basic surgical experience, no specialized skills Basic equipment only
External fixator (midshaft/distal shaft) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
External fixator (subtrochanteric) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing (subtrochanteric) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Antegrade nailing (midshaft/distal shaft) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing (midshaft/distal shaft) Closed fractures, Gustilo types I & II open fractures, stable polytrauma. “Floating knee” injury, bilateral lower extremity fractures. Pregnancy. Obesity. Ipsilateral femoral neck and shaft fractures. Concomitant ipsilateral acetabular / pelvic ring fractures. Fracture below hip prosthesis. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Compression plating - DCS (subtrochanteric) Failed indirect reduction, polytrauma with chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Compression plating - locking plate (subtrochanteric) Failed indirect reduction, polytrauma with chest injury, early pregnancy, image intensification not available Some specialized surgical experience Simple surgical and imaging resources
Lag screw with protection plate (midshaft) Failed indirect reduction, polytrauma with chest injury, early pregnancy, image intensification not available Highly experienced and skilled surgeon Simple surgical and imaging resources
Compression plating - DCS (distal shaft) Failed indirect reduction, polytrauma with chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
A3

Simple transverse fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Temporary Thomas splint Medically unfit for surgery. Usually temporary Basic surgical experience, no specialized skills Basic equipment only
External fixator (midshaft/distal shaft) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
External fixator (subtrochanteric) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing (subtrochanteric) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Antegrade nailing (midshaft/distal shaft) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing (midshaft/distal shaft) Closed fractures, Gustilo types I & II open fractures, stable polytrauma. “Floating knee” injury, bilateral lower extremity fractures. Pregnancy. Obesity. Ipsilateral femoral neck and shaft fractures. Concomitant ipsilateral acetabular / pelvic ring fractures. Fracture below hip prosthesis. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Compression plating - DCS (subtrochanteric) Failed indirect reduction, polytrauma with chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Compression plating - locking plate (subtrochanteric) Failed indirect reduction, polytrauma with chest injury, early pregnancy, image intensification not available Some specialized surgical experience Simple surgical and imaging resources
Compression plating - blade plate (subtrochanteric) Failed indirect reduction, polytrauma with chest injury, early pregnancy, (image intensification not available) Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Compression plating (midshaft) Failed indirect reduction, polytrauma with chest injury, early pregnancy, image intensification not available Highly experienced and skilled surgeon Simple surgical and imaging resources
Compression plating - DCS (distal shaft) Failed indirect reduction, polytrauma with chest injury Some specialized surgical experience Full specialized surgical and imaging resources
B1

Wedge fractures, spiral wedge

Please select a treatment option:
Treatment Indication summary Skill Equipment
Temporary Thomas splint Medically unfit for surgery. Usually temporary Basic surgical experience, no specialized skills Basic equipment only
External fixator (midshaft/distal shaft) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
External fixator (subtrochanteric) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing (subtrochanteric) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Antegrade nailing (midshaft/distal shaft) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing (midshaft/distal shaft) Closed fractures, Gustilo types I & II open fractures, stable polytrauma. “Floating knee” injury, bilateral lower extremity fractures. Pregnancy. Obesity. Ipsilateral femoral neck and shaft fractures. Concomitant ipsilateral acetabular / pelvic ring fractures. Fracture below hip prosthesis. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - locking plate (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - DCS (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - (midshaft) Polytrauma with associated chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - DCS (distal shaft) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - LISS (distal shaft) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (ORIF) - DCS (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference, failed indirect reduction Some specialized surgical experience Full specialized surgical and imaging resources
Bridge plating (ORIF) - locking plate (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference, image intensification not available, failed indirect reduction Some specialized surgical experience Simple surgical and imaging resources
Lag screw with protection plate (midshaft) Polytrauma with associated chest injury, surgeon's preference, image intensification not available, failed indirect reduction Highly experienced and skilled surgeon Simple surgical and imaging resources
Bridge plating (midshaft) Polytrauma with associated chest injury, surgeon's preference, image intensification not available, failed indirect reduction Some specialized surgical experience Simple surgical and imaging resources
Bridge plating - DCS (distal shaft) Polytrauma with associated chest injury, failed indirect reduction Some specialized surgical experience Full specialized surgical and imaging resources
B2

Wedge fractures, bending wedge

Please select a treatment option:
Treatment Indication summary Skill Equipment
Temporary Thomas splint Medically unfit for surgery. Usually temporary Basic surgical experience, no specialized skills Basic equipment only
External fixator (midshaft/distal shaft) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
External fixator (subtrochanteric) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing (subtrochanteric) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Antegrade nailing (midshaft/distal shaft) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing (midshaft/distal shaft) Closed fractures, Gustilo types I & II open fractures, stable polytrauma. “Floating knee” injury, bilateral lower extremity fractures. Pregnancy. Obesity. Ipsilateral femoral neck and shaft fractures. Concomitant ipsilateral acetabular / pelvic ring fractures. Fracture below hip prosthesis. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - DCS (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - locking plate (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - (midshaft) Polytrauma with associated chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - DCS (distal shaft) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - LISS (distal shaft) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating - DCS (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference, failed indirect reduction Some specialized surgical experience Full specialized surgical and imaging resources
Bridge plating - locking plate (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference, image intensification not available, failed indirect reduction Some specialized surgical experience Simple surgical and imaging resources
Lag screw with protection plate (midshaft) Polytrauma with associated chest injury, surgeon's preference, image intensification not available, failed indirect reduction Highly experienced and skilled surgeon Simple surgical and imaging resources
Bridge plating (midshaft) Polytrauma with associated chest injury, surgeon's preference, image intensification not available, failed indirect reduction Some specialized surgical experience Simple surgical and imaging resources
Bridge plating - DCS (distal shaft) Polytrauma with associated chest injury, failed indirect reduction Some specialized surgical experience Full specialized surgical and imaging resources
B3

Wedge fractures, fragmented wedge

Please select a treatment option:
Treatment Indication summary Skill Equipment
Temporary Thomas splint Medically unfit for surgery. Usually temporary Basic surgical experience, no specialized skills Basic equipment only
External fixator (midshaft/distal shaft) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
External fixator (subtrochanteric) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing (subtrochanteric) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Antegrade nailing (midshaft/distal shaft) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing (midshaft/distal shaft) Closed fractures, Gustilo types I & II open fractures, stable polytrauma. “Floating knee” injury, bilateral lower extremity fractures. Pregnancy. Obesity. Ipsilateral femoral neck and shaft fractures. Concomitant ipsilateral acetabular / pelvic ring fractures. Fracture below hip prosthesis. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - DCS (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - locking plate (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - (midshaft) Polytrauma with associated chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - DCS (distal shaft) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - LISS (distal shaft) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating - DCS (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference, failed indirect reduction Some specialized surgical experience Full specialized surgical and imaging resources
Bridge plating - locking plate (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference, image intensification not available, failed indirect reduction Some specialized surgical experience Simple surgical and imaging resources
Bridge plating (midshaft) Polytrauma with associated chest injury, surgeon's preference, image intensification not available, failed indirect reduction Some specialized surgical experience Simple surgical and imaging resources
Bridge plating - DCS (distal shaft) Polytrauma with associated chest injury, failed indirect reduction Some specialized surgical experience Full specialized surgical and imaging resources
C1

Complex fractures, spiral

Please select a treatment option:
Treatment Indication summary Skill Equipment
Temporary Thomas splint Medically unfit for surgery. Usually temporary Basic surgical experience, no specialized skills Basic equipment only
External fixator (midshaft/distal shaft) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
External fixator (subtrochanteric) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing (subtrochanteric) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Antegrade nailing (midshaft/distal shaft) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing (midshaft/distal shaft) Closed fractures, Gustilo types I & II open fractures, stable polytrauma. “Floating knee” injury, bilateral lower extremity fractures. Pregnancy. Obesity. Ipsilateral femoral neck and shaft fractures. Concomitant ipsilateral acetabular / pelvic ring fractures. Fracture below hip prosthesis. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - DCS (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - locking plate (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - (midshaft) Polytrauma with associated chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - DCS (distal shaft) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - LISS (distal shaft) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating - DCS (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference, failed indirect reduction Some specialized surgical experience Full specialized surgical and imaging resources
Bridge plating - locking plate (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference, image intensification not available, failed indirect reduction Some specialized surgical experience Simple surgical and imaging resources
Bridge plating (midshaft) Polytrauma with associated chest injury, surgeon's preference, image intensification not available, failed indirect reduction Some specialized surgical experience Simple surgical and imaging resources
Bridge plating - DCS (distal shaft) Polytrauma with associated chest injury, failed indirect reduction Some specialized surgical experience Full specialized surgical and imaging resources
C2

Complex fractures, segmented

Please select a treatment option:
Treatment Indication summary Skill Equipment
Temporary Thomas splint Medically unfit for surgery. Usually temporary Basic surgical experience, no specialized skills Basic equipment only
External fixator (midshaft/distal shaft) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
External fixator (subtrochanteric) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing (subtrochanteric) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Antegrade nailing (midshaft/distal shaft) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing (midshaft/distal shaft) Closed fractures, Gustilo types I & II open fractures, stable polytrauma. “Floating knee” injury, bilateral lower extremity fractures. Pregnancy. Obesity. Ipsilateral femoral neck and shaft fractures. Concomitant ipsilateral acetabular / pelvic ring fractures. Fracture below hip prosthesis. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - DCS (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - locking plate (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - (midshaft) Polytrauma with associated chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - DCS (distal shaft) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - LISS (distal shaft) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating - DCS (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference, failed indirect reduction Some specialized surgical experience Full specialized surgical and imaging resources
Bridge plating - locking plate (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference, image intensification not available, failed indirect reduction Some specialized surgical experience Simple surgical and imaging resources
Bridge plating (midshaft) Polytrauma with associated chest injury, surgeon's preference, image intensification not available, failed indirect reduction Some specialized surgical experience Simple surgical and imaging resources
Bridge plating - DCS (distal shaft) Polytrauma with associated chest injury, failed indirect reduction Some specialized surgical experience Full specialized surgical and imaging resources
C3

Complex fractures, irregular

Please select a treatment option:
Treatment Indication summary Skill Equipment
Temporary Thomas splint Medically unfit for surgery. Usually temporary Basic surgical experience, no specialized skills Basic equipment only
External fixator (midshaft/distal shaft) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
External fixator (subtrochanteric) Unstable fracture, patient or soft tissues unsuitable for definitive internal fixation Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing (subtrochanteric) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Antegrade nailing (midshaft/distal shaft) Closed isolated fractures, Gustilo I and II open fractures, stable polytrauma Some specialized surgical experience Full specialized surgical and imaging resources
Retrograde nailing (midshaft/distal shaft) Closed fractures, Gustilo types I & II open fractures, stable polytrauma. “Floating knee” injury, bilateral lower extremity fractures. Pregnancy. Obesity. Ipsilateral femoral neck and shaft fractures. Concomitant ipsilateral acetabular / pelvic ring fractures. Fracture below hip prosthesis. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - DCS (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - locking plate (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - (midshaft) Polytrauma with associated chest injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - DCS (distal shaft) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating (MIO) - LISS (distal shaft) Polytrauma with associated chest injury, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating - DCS (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference, failed indirect reduction Some specialized surgical experience Full specialized surgical and imaging resources
Bridge plating - locking plate (subtrochanteric) Polytrauma with associated chest injury, surgeon's preference, image intensification not available, failed indirect reduction Some specialized surgical experience Simple surgical and imaging resources
Bridge plating (midshaft) Polytrauma with associated chest injury, surgeon's preference, image intensification not available, failed indirect reduction Some specialized surgical experience Simple surgical and imaging resources
Bridge plating - DCS (distal shaft) Polytrauma with associated chest injury, failed indirect reduction Some specialized surgical experience Full specialized surgical and imaging resources

Special considerations

Principles of management of open fractures
Complications
Infection
Compartment syndrome
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2016-10-24