Case Study - Fractures in Disasters and Conflict
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Title[edit | edit source]
Poly-trauma with Complex Fracture following Explosion [1]
Abstract[edit | edit source]
Mr Abukhair is a 34-year-old male who presented to emergency room (ER) with a displaced pelvic fracture, bilateral femoral fractures and left tibial fracture with extensive blood loss 3hrs following an explosion. Mr Abukhair underwent surgery for intrameduallary (IM) nails of both femurs, left tibia external fixation and conservative management of pelvic fractures requiring extensive stay in ICU followed by bed rest impacting on 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 is a 34-year-old male who presented to the emergency room (ER) following an explosion, where he was thrown around 100m from the blast site. He was semi-conscious when he was brought to the ER after three hours of injury, with massive blood loss. He was immediately admitted to the intensive care unit (ICU) following initial conservative management.
On investigation, a CT head scan revealed no abnormal findings, but AP, lateral and oblique x-rays confirmed multiple fractures: displaced pelvic fracture, bilateral femoral fractures and left tibial fracture. The patient’s neurovascular exam was normal.
While in ICU, his treatment included:
- blood transfusions
- intrameduallary (IM) nails of both femurs
- left tibia external fixation
- conservative management of pelvic fractures
After 18 days in the ICU, Mr Abukhair was transferred to the orthopedic ward. Bed rest was advised for six weeks, due to the pelvic fracture, 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.
