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Case report: treatment of open femoral shaft fracture in a severely burned patient.

Chang TL, Spence RJ, Mears SC - Eplasty (2008)

Bottom Line: The patient was treated with intubation, intravenous antibiotics, and debridement and intramedullary nailing for the femur fracture.The patient was returned to full weightbearing and good function with a fully healed femur.Treatment of open fractures in burn patients should be tailored to the specific needs of the individual; they should be reduced and stabilized via internal fixation at the earliest opportunity and should be managed by minimizing wound colonization through successive debridement, wound care, and consideration of flap coverage.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Johns Hopkins University/Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.

ABSTRACT

Objective: To present a case report of a patient with an open fracture and severe burns and review the literature.

Methods: The patient was treated with intubation, intravenous antibiotics, and debridement and intramedullary nailing for the femur fracture. He later underwent multiple burn excision procedures with allograft and autograft skin coverage. The wound over the fracture was treated with dressing changes. The fracture was treated with nail exchange and bone grafting for atrophic nonunion.

Results: The patient was returned to full weightbearing and good function with a fully healed femur.

Conclusions: Treatment of open fractures in burn patients should be tailored to the specific needs of the individual; they should be reduced and stabilized via internal fixation at the earliest opportunity and should be managed by minimizing wound colonization through successive debridement, wound care, and consideration of flap coverage.

No MeSH data available.


Related in: MedlinePlus

Postoperative anteroposterior radiograph shows reduction and intramedullary fixation of the right femur.
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Figure 2: Postoperative anteroposterior radiograph shows reduction and intramedullary fixation of the right femur.

Mentions: The patient received intravenous cefazolin and a tetanus immunization in the emergency department and was admitted to the burn intensive care unit. The open femur fracture was irrigated with a liter of isotonic sodium chloride solution. The wounds were dressed, and the leg was splinted. The patient was taken to the operating room for debridement of the fracture and skeletal stabilization. The nonviable skin edges of the open fracture sites were debrided sharply. Gross contamination, which included several pieces of grass or other organic material, was removed. The patient's open fracture was then irrigated with 10 L of isotonic sodium chloride solution via pulse lavage. After the open fracture had been irrigated thoroughly, instruments were changed, and attention was turned to stabilizing the femur. The patient was transferred to a fracture table. After fracture reduction, the femoral canal was reamed to 15 mm, and a 14 × 380 mm locked T2 femoral nail (Stryker, Mahwah, NJ) was placed (Fig 2). The rotational alignment and length of the patient's right leg were checked in comparison to the left leg and thought to be acceptable. The open fracture wounds were closed loosely with 2-0 vertical mattress nylon sutures. The patient was kept intubated and was transferred to the burn intensive care unit.


Case report: treatment of open femoral shaft fracture in a severely burned patient.

Chang TL, Spence RJ, Mears SC - Eplasty (2008)

Postoperative anteroposterior radiograph shows reduction and intramedullary fixation of the right femur.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2289779&req=5

Figure 2: Postoperative anteroposterior radiograph shows reduction and intramedullary fixation of the right femur.
Mentions: The patient received intravenous cefazolin and a tetanus immunization in the emergency department and was admitted to the burn intensive care unit. The open femur fracture was irrigated with a liter of isotonic sodium chloride solution. The wounds were dressed, and the leg was splinted. The patient was taken to the operating room for debridement of the fracture and skeletal stabilization. The nonviable skin edges of the open fracture sites were debrided sharply. Gross contamination, which included several pieces of grass or other organic material, was removed. The patient's open fracture was then irrigated with 10 L of isotonic sodium chloride solution via pulse lavage. After the open fracture had been irrigated thoroughly, instruments were changed, and attention was turned to stabilizing the femur. The patient was transferred to a fracture table. After fracture reduction, the femoral canal was reamed to 15 mm, and a 14 × 380 mm locked T2 femoral nail (Stryker, Mahwah, NJ) was placed (Fig 2). The rotational alignment and length of the patient's right leg were checked in comparison to the left leg and thought to be acceptable. The open fracture wounds were closed loosely with 2-0 vertical mattress nylon sutures. The patient was kept intubated and was transferred to the burn intensive care unit.

Bottom Line: The patient was treated with intubation, intravenous antibiotics, and debridement and intramedullary nailing for the femur fracture.The patient was returned to full weightbearing and good function with a fully healed femur.Treatment of open fractures in burn patients should be tailored to the specific needs of the individual; they should be reduced and stabilized via internal fixation at the earliest opportunity and should be managed by minimizing wound colonization through successive debridement, wound care, and consideration of flap coverage.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Johns Hopkins University/Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.

ABSTRACT

Objective: To present a case report of a patient with an open fracture and severe burns and review the literature.

Methods: The patient was treated with intubation, intravenous antibiotics, and debridement and intramedullary nailing for the femur fracture. He later underwent multiple burn excision procedures with allograft and autograft skin coverage. The wound over the fracture was treated with dressing changes. The fracture was treated with nail exchange and bone grafting for atrophic nonunion.

Results: The patient was returned to full weightbearing and good function with a fully healed femur.

Conclusions: Treatment of open fractures in burn patients should be tailored to the specific needs of the individual; they should be reduced and stabilized via internal fixation at the earliest opportunity and should be managed by minimizing wound colonization through successive debridement, wound care, and consideration of flap coverage.

No MeSH data available.


Related in: MedlinePlus