Musculoskeletal case studies for medical students
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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.
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.