. Open Femur Fracture. OrthopaedicsOne Cases. In: OrthopaedicsOne - The Orthopaedic Knowledge Network. Created Apr 20, 2012 10:53. Last modified Jul 16, 2012 05:10 ver.10. Retrieved 2019-07-22, from https://www.orthopaedicsone.com/x/bITtB.
This male patient sustained a penetrating blast injury to his left thigh from an improvised explosive device (IED), resulting in an open femur fracture. These are some of the most commonly encountered injuries in the current combat environment. All general and orthopaedic surgeons should have a thorough understanding of extremity anatomy and treatment options for these injuries. Surgeons should be familiar with the standard constructs of external fixation.
Physical examination revealed an isolated injury to the left thigh, with a 3-cm wound at the distal third of the anterolateral thigh. Neurological and vascular examinations were normal. The thigh was moderately swollen, and a retained fragment noted radiographically was not palpable. Plain radiographs showed a long, spiral oblique fracture of the femur, with a fragment proximal to the fracture site (Figure 1).
In the operating room, the patient underwent irrigation and debridement of the fracture and placement of an external fixator spanning the knee joint (Figures 2-3). The traumatic wound was extended to improve exposure. This extension was closed at the end of the procedure, leaving the traumatic wound open. The open wound was packed with wet-to-dry dressings soaked with Dakin’s solution. Intravenous antibiotics were administered, and the patient was evacuated on the day of injury.