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Orthogate  Cases Trauma Bilateral Femoral Fractures
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Bilateral Femoral Fractures |
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Click on images
to view radiographs and clinical pictures.
Introduction
This 82 year old lady slipped and fell while
she was pushing her shopping cart across an icy parking lot.
She was unable to get up from her fall and was taken to
hospital. In the emergency room, she complained of pain in
both legs. She was neurovascularly intact, had deformities
of both thighs, and there were no open injuries. Examination
of both hips, ankles, and feet were normal. The pelvis was
stable and nontender. Radiographs were obtained after
splinting her legs (below).
Radiographs of the Right Femur in the Emergency Room
Radiographs of the Left Femur in the Emergency Room
What is your diagnosis and management ?
This patient has a comminuted supracondylar
left femoral fracture and an oblique fracture of the right femur
at the junction of the middle and distal thirds. There is
also an undisplaced oblique fracture of the right femur in the
distal third. In the emergency department, bilateral
Thomas splints were applied and after informed consent was
obtained, the patient was taken to the operating room for
fixation of both fractures. The original plan was to
perform a closed intramedullary nailing of the right femur and
an open reduction and internal fixation with an eight-hole,
95-degree dynamic condylar screw on the left side.
However, due to the undisplaced oblique diaphyseal right femoral
fracture, management of that femur was revised to open reduction,
cerclage wiring of the distal femoral fragment, and fracture
fixation with a 12-hole 95-degree dynamic condylar screw over
the cerclage wires (below).
Postoperative Radiographs of Both Femora
What is your postoperative management ?
Postoperatively, the two Jones Bandages and
Hemovac drains were removed at the 48-hour mark. We plan
to limit activity to bed-to-chair assisted transfers only for
six weeks to three months.
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