Professional Documents
Culture Documents
BSN 3I
Case 2
A 23-year-old man sustained an isolated right subtrochanteric femoral
fracture as an unrestrained driver in a motor vehicle accident. On physical
examination in the emergency room, he was alert, oriented, and without
complaints of injury to the left leg. Vascular and neurologic findings were
normal in both legs. The right thigh had no open wounds but was swollen
and painful. Radiographs showed that this fracture had a large area of
comminution with an unstable configuration.
The operative procedure, using a Zimmer intramedullary
reconstruction nail (Warsaw, Ind), done on a Jackson fracture table
(Orthopedic Systems Inc, Union City, Calif) with the right leg elevated in a
padded stirrup. The procedure lasted 3 hours 45 minutes. At the end of the
procedure, but before extubation, a "secondary survey" physical
examination was done. During this examination, the left, elevated leg was
found to be swollen and tense. A Stryker 295-2 Quick Pressure Monitor Set
was used to measure the compartment pressures that ranged between 50
and 80 mm Hg in all four compartments of the leg. The patient was then
transferred onto a regular operating room table, and all of the leg
compartments were released with fasciotomies. Postoperatively, the patient
had global paresthesias on the plantar and dorsal surfaces of the affected
foot to the area of the malleoli.
Three months later, the patient continued to have moderate pain in
the thigh and paresthesias in the foot. Radiographs at that time showed a
healing fracture, and progressive weight-bearing was started. Over the next
3 months, the thigh pain diminished, and he was able to return to work as a
brick mason; however, he continued to have a global lack of sensation on the
left foot from the malleoli distally.
At final follow-up 2 years after the injury, radiographs showed a healed
fracture (Fig 2). The leg lengths were not symmetric, the right side being
shorter than the right by 2 cm. The paresthesias that began after surgery
had not resolved. His gait was not antalgic, but he reported moderate thigh
and foot pain when standing for 3 hours or more. The patient expressed
satisfaction with the surgery but did complain that his foot pain
compromised the number of hours he could work in a day.
REFERENCE: http://www.medscape.com/viewarticle/429552_2