Case conference Ext.Sanichaya

Case• ผปวยชายไทย อาย 15 ป อาชพ นกเรยน• ภมลำาเนา อ. หนองบญมาก จ.นครราชสมา

Chief complaint

• ปวดตนขาขางขวา 3 ชวโมง PTA

Primary survey

•A : patent airway, no stidor, c-spine not tender•B : normal breath sound, no dyspnea, trachea in

midline, clear both lungs•C : BP 140/83 mmHg, no active bleeding•D : E5V5M6, pupil 3 mm.RTLBE• E : intact

Secondary survey• A : no drug/food allergy•M : no medication• P : no u/d• L : last meal ลกชน 20.00 น.• E : 3 ชม. PTA ผปวยใหประวตวาขบรถมอเตอรไซคชนรถเกง ไม

สลบ จำาเหตการณได ไมมศรษะกระแทกพน ขยบตนขาขวาไมไดรสกปวดทตนขาขวา

Diagnosis•Closed fracture shaft of femur Rt.

Treatment•On skeletal traction 5 kg.•Plan surgery

Fracture shaft of femur

Anatomy

• largest and strongest bone• an anterior bow • linea aspera

Muscle3 compartments of the thigh •Anterior : sartorius, quadriceps•Posterior : biceps, femoris, semitendinosus,

semimembranosus•Adductor : gracilis, adductor longus, adductor brevis,

adductor magnus

Fracture shaft of femur• The longest and strongest bone in your body•High energy injuries frequently associated with life-

threatening conditions• Incidence 37.1 per 100,000 person-years

Mechanism of injury

• Traumaticohigh-energy• most common in younger population• often a result of high-speed motor vehicle accidents

olow-energy• more common in elderly• often a result of a fall from standing• gunshot

Associated conditions• ipsilateral femoral neck fracture •bilateral femur fracturesosignificant risk of pulmonary complicationsoincreased rate of mortality as compared to

unilateral fractures

OTA Classification

Symptoms • immediate, severe pain•not be able to put weight on the injured leg•may look deformed

Physical Examination • Inspection• tense, swollen thigh, tenderness about thigh

• motion• examination for ipsilateral femoral neck fracture often difficult

secondary to pain from fracture• Neurovascular

Radiographs

•AP and lateral views of entire femur•AP and lateral views of ipsilateral hip•AP and lateral views of ipsilateral knee•CT• Indications - rule-out associated femoral neck

fracture

Treatment•Most femoral shaft fractures require surgery to heal•Very young children are sometimes treated with a cast

Treatment

• Initial care• a long-leg splint or in skeletal traction• External fixation is used to hold the bones

together temporarily when the skin and muscles have been injured

Treatment • Intramedullary nailing•Plates and screws

Complications

•Blood vessels or nerve injury•Acute compartment syndrome• Infection from open fractures

Complications from Surgery

• Infection• Injury to nerves and blood vessels• Blood clots• Fat embolism• Malalignment or the inability to correctly position the broken bone

fragments• Delayed union or nonunion (when the fracture heals slower than

usual or not at all)• Hardware irritation

Thank you