Femur, shaft: wedge fracture, fragmented wedge—32-B3


Femur, shaft: wedge fracture, fragmented wedge—32-B3

Suthorn Bavonratanavech

Case description

A 35-year-old man was hit by a truck and sustained a closed fracture of the left femoral shaft with an ipsilateral closed tibial fracture. His right lower leg was amputated as he sustained an open fracture from a severe crush injury. He suffered no neurological damage and was in a stable condition to allow transfer to the author‘s hospital.

Indication for MIPO

As this case was the result of a high-energy injury, there was considerable soft-tissue damage in the left leg so that even though it was a closed injury, external fixation of the tibial fracture was the treatment of choice. The external fixation of the left tibia should be performed first, and as the patient was placed on a normal operating table it is more practical to proceed for stabilization of the femoral fracture using a plate by MIPO technique. As the right leg had been amputated, indirect reduction was a good alternative because obtaining correct length was not so important. There was also no need for early weight bearing; it would take at least 2 months before a prosthesis could be fitted.

a–b Preoperative injury films.

Preoperative planning

a–b A 16-hole broad DCP 4.5 is introduced submuscularly from the proximal to the distal femur. After the plate is positioned on the bone, it is fixed proximally at the level of the vastus ridge. c–d Manual traction and screw fixation distally are performed at the mid point of and perpendicular to the femur at the third last hole. The plate is fixed proximally and distally in the proper alignment. To obtain correct length, an additional screw is inserted about 1–1.5 cm distal to the end of the plate as the anchorage screw. e–f A bone spreader is inserted between the end of the plate and the head of the anchorage screw, then the screw from the third distal hole is removed before the spreader is used to push the plate to gain correct length. The screw is inserted in the second-last hole and alignment is checked before additional screws are added.

Jul 2, 2020 | Posted by in ORTHOPEDIC | Comments Off on Femur, shaft: wedge fracture, fragmented wedge—32-B3
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