Boero Emanuele, Mogollo Maria del Amparo Paredes
Department of Orthopaedics and Traumatology, Pietro Cosma Hospital, Camposampiero PD, Italy.
Department of Orthopaedics and Traumatology, Pietro Cosma Hospital, Camposampiero PD, Italy.
Injury. 2015 Dec;46 Suppl 7:S31-4. doi: 10.1016/S0020-1383(15)30042-5.
A 20-year-old man was admitted to our hospital having sustianed bilateral high-energy femoral fractures. The right femoral fracture was an open grade 3B with OTA grade 3 bone loss. The patient had also a brain contusion with a subdural haematoma and a closed fracture of the left clavicle. Initial management included temporarily stabilisation of the femoral fractures wth external fixators and prompt transfer to the intensive care unit. Three weeks later the external fixator of the right femur was converted to an hybrid system, and the fixator of the left side was removed and a reamed intramedullary locking nail was applied. Two months after the accident the patient underwent bone transport (11 cm long) of the right femur with an monolateral external fixation. When the final length was achieved there were knee stiffness (ROM 0° to 30°) and non-union of the docking site. Therefore, the patient underwent a Judet's procedure to treat the knee stiffness and stabilisation of the non united femur with a locking plate (LISS). After the operation the patient started progressive weight bearing. A year after trauma and following union of the femur, the patient underwent soft tissue reconstruction of the anterior side of the thigh with a free vascularised flap. At final follow upo the patient had a good functional recovery with return to his previous occupation.
一名20岁男性因双侧高能股骨骨折入院。右侧股骨骨折为开放性3B级，伴有OTA 3级骨缺损。患者还伴有脑挫伤并硬膜下血肿以及左侧锁骨闭合性骨折。初始治疗包括用外固定器临时固定股骨骨折，并迅速转入重症监护病房。三周后，右侧股骨的外固定器转换为混合系统，左侧的固定器被拆除并应用了扩髓髓内锁定钉。事故发生两个月后，患者对右侧股骨进行了11厘米长的骨搬运，并采用单侧外固定。当达到最终长度时，出现了膝关节僵硬（活动范围0°至30°）以及对接部位骨不连。因此，患者接受了朱代手术以治疗膝关节僵硬，并使用锁定钢板（LISS）稳定股骨骨不连部位。术后患者开始逐步负重。创伤一年后，股骨愈合，患者接受了带血管游离皮瓣对大腿前侧进行软组织重建。最后一次随访时，患者功能恢复良好，重返先前工作岗位。
