Musculoskeletal case studies for medical students

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History

A 43 year old male was involved in a motor accident. He complained of left hip pain. He also had a closed fracture of his left tibia. He was haemodynamically stable and had no neurovascular injuries.

Initial X ray
Description AP X ray
X ray
Description X ray of the other injury
Problem The 43 year old male with multiple injuries after a car accident: Management regarding the proximal femur fracture.
X ray after treatment
Description After open reduction
Post management further view
Description
Classification Multiple injurys are present. There is an un-displaced fracture of the left proximal femur. It is an extracapsular (intertochanteric) fracture. The ipsilateral tibia has a segmental fracture.
Discussion of management

The patient was resuscitated and an intravenous line was inserted. His proximal femur fracture, although undisplaced, will require fixation. The fact that there are multiple injuries mandated ORIF of all long bone fractures. The proximal fracture was fixed with a sliding screw and plate. The tibia fracture was fixed with an intramedullary rod. Segmental fractures of the tibia are difficult to control by conservative means.

Most intertrochanteric fractures are seen in the elderly. Here the motivation for fixation (in the elderly) is to mobilise the patient as soon as possible, before they develop the complications of bed riddance. Intertrochanteric femur fractures also have a tendency to unite in varus if conservative treatment with traction is undertaken.

 

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