Case Study - Fractures in Disasters and Conflict: Difference between revisions
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'''Original Editors ''' - [[User:Naomi O Reilly|Naomi O Reilly]] | '''Original Editors ''' - [[User:Naomi O Reilly|Naomi O Reilly]] | ||
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== Abstract == | == Abstract == | ||
Mr Abukhair | Mr Abukhair, a 34-year-old male, presented to emergency room (ER) following an explosion. Injuries obtained include; a displaced pelvic fracture, bilateral femoral fractures and left tibial fracture with extensive blood loss. Consequently, Mr Abukhair had an external fixation of the left tibia, intramedullary (IM) nail fixation of bilateral femurs and conservative management of pelvic fractures. This resulted in a extensive stay in ICU followed by bed rest, impacting early rehabilitation. | ||
== Key Words == | == Key Words == | ||
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=== Past Medical History === | === Past Medical History === | ||
Mr Abukhair | Mr Abukhair aged 34-year-old, presented to the emergency room (ER) following an explosion, where he was thrown approximately 100m from the blast site. Approximately three hours later, he was brought in by ambulance in a semi-conscious state with extreme blood loss. He was immediately admitted to the intensive care unit (ICU) following initial conservative management. | ||
On investigation, | On further investigation, CT head scan revealed no abnormal findings and a normal neurovascular exam. However, various views on x-ray (AP, lateral and oblique) confirmed multiple fractures: displaced pelvic fracture, bilateral femoral fractures and left tibial fracture. | ||
ICU treatments included: | |||
* blood transfusions | * blood transfusions | ||
* | * Intramedullary (IM) nails of bilateral femurs | ||
* left tibia external fixation | * left tibia external fixation | ||
* conservative management of pelvic fractures | * conservative management of pelvic fractures | ||
After 18 days in the ICU, Mr Abukhair was transferred to the orthopaedic ward. Due to the pelvic fracture, bed rest was advised for six weeks, with no movement at the hip joint permitted. He did not receive any rehabilitation treatment during his stay in the ICU. | |||
After 18 days in the ICU, Mr Abukhair was transferred to the | |||
=== Social History === | === Social History === | ||
Revision as of 18:19, 14 March 2022
Original Editors - Naomi O Reilly
Top Contributors - Naomi O'Reilly, Kalyani Yajnanarayan, Kim Jackson, Rachael Lowe, Jess Bell and Olajumoke Ogunleye
This article is currently under review and may not be up to date. Please come back soon to see the finished work! (14/03/2022)
Title[edit | edit source]
Poly-trauma with Complex Fracture following Explosion [1]
Abstract[edit | edit source]
Mr Abukhair, a 34-year-old male, presented to emergency room (ER) following an explosion. Injuries obtained include; a displaced pelvic fracture, bilateral femoral fractures and left tibial fracture with extensive blood loss. Consequently, Mr Abukhair had an external fixation of the left tibia, intramedullary (IM) nail fixation of bilateral femurs and conservative management of pelvic fractures. This resulted in a extensive stay in ICU followed by bed rest, impacting early rehabilitation.
Key Words [edit | edit source]
Poly-trauma, Fractures, Explosion, Conflict
Patient Characteristics[edit | edit source]
Past Medical History[edit | edit source]
Mr Abukhair aged 34-year-old, presented to the emergency room (ER) following an explosion, where he was thrown approximately 100m from the blast site. Approximately three hours later, he was brought in by ambulance in a semi-conscious state with extreme blood loss. He was immediately admitted to the intensive care unit (ICU) following initial conservative management.
On further investigation, CT head scan revealed no abnormal findings and a normal neurovascular exam. However, various views on x-ray (AP, lateral and oblique) confirmed multiple fractures: displaced pelvic fracture, bilateral femoral fractures and left tibial fracture.
ICU treatments included:
- blood transfusions
- Intramedullary (IM) nails of bilateral femurs
- left tibia external fixation
- conservative management of pelvic fractures
After 18 days in the ICU, Mr Abukhair was transferred to the orthopaedic ward. Due to the pelvic fracture, bed rest was advised for six weeks, with no movement at the hip joint permitted. He did not receive any rehabilitation treatment during his stay in the ICU.
Social History[edit | edit source]
Chronic smoker for 12 years and chews khat (a local stimulant).
Family History: 6 children. His brother is his main carer while he is in hospital.
Examination Findings[edit | edit source]
Observations[edit | edit source]
Positioning: Lying in supine position with head slightly elevated, IV cannula and urinary catheter in-situ
Hardware: External fixator left tibia
Scar: Long scar running along lateral site of bilateral thighs, bilateral quadriceps muscles wasting
Swelling: Bilateral lower limb swelling (from toes to knees)
Skin: Dry, broken, pale skin over foot and ankle
Pain: Obvious pain on movement of toes and ankles
Pain Assessment[edit | edit source]
Numeric Pain Rating Scale: 7/10 (in rest), 9/10 with slight movement
Aggravating Factor: Any movement in lower limb
Relieving Factor: Rest in supine position with slight abduction and external rotation of hip and medication
Location of Pain: At the hip joint, knee and over the buttock areas
Physical Examination[edit | edit source]
Range of Movement[edit | edit source]
Passive ROM: Slight limitation in bilateral ankle and toes due to pain, Knee flexion; right 20 degrees, left 35 degrees
Active ROM: Complains of pain but can attempt slight movement, not full range
Strength[edit | edit source]
Dorsiflexion 3+/5
Plantarflexion 4/5
Unable to perform isometric quadriceps contraction due to pain 1/5
References [edit | edit source]
- ↑ Lathia C, Skelton P, Clift Z. Early Rehabilitation in Conflicts and Disasters. Handicap International: London, UK. 2020.
