Answer
1) Describe the radiographic finding
Complete oblique fracture of the distal left femur with angulation and shortening.
2) What other injury that you are looking for
High speed injury (>40 MPH @ 64 Km/hr in adult, and >20MPH in children) may cause poly trauma and hence should be evaluated for the injury to the chest, pelvic and brain.
Apart from that, a clinical suspicion of pattelar fracture, ligamentous injury of knee and ipsilateral leg fracture should be suspected if patient have distal femur fracture.
3) Complication that this patient may have?
Hypovolumic shock (blood loss 0.5-1 liter)
Fat embolism
Compartment syndrome
Delayed, malunion and non union in neglected case
Limb shortening
knee stiffness
Infection
4) Outline the management for this patient?
Notes: as being mentioned before, physician should exclude others injury for the high speed injury and treat them accordingly. However, in this section i will only discuss about management of closed fracture of distal femur.
- The principle of fracture management is the same which is reduce, hold, exercise and pain management with appropriate analgesia.
- Fluid resuscitation should be commerced if hypovolumia present. If necessary, blood transfusion might be required
-Definitive treatment is internal fixation as the strong muscle action will cause the fracture easily displaced and not suitable for cast or conservative management.
- Skin or skeletal traction while waiting for the definitive treatment will help to reduce the fracture and relieve muscle spasm (reduce pain)