Case of the Month – Hip Injury – Part 2 Now Live

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The surgeon immediately recognized that Spc Walsh had a closed left hip fracture dislocation and without delay attempted a manual closed reduction. Unfortunately, this was not successful, even with the patient under anesthesia. The surgeon then attempted another closed reduction, this time with a Steinmann pin placed in the proximal femur. The fracture, however, was found to be irreducible.

The surgeon decided to perform an open reduction with internal fixation of the Pipkin 2 femoral head fracture.

figure 5

The patient was then transported by aeromedical evacuation back to his home country where he reportedly went on to complete his healing and recovery without significant complication.

Orthopaedics in Motion – Winter 2012 is now available online

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Orthopaedics in Motion – Volume 1, Number 4 – Winter 2012 is now available online.

Orthopaedics in Motion is a quarterly newsletter containing sections on disaster preparedness and trauma care. The newsletter also includes overviews of the latest aspects of clinic care, continuing education, research and innovation pertinent to the practicing orthopaedic surgeon.

For Orthopaedics in Motion – Volume 1, Number 3 – Fall 2011 please visit The Disaster Preparedness Toolbox and click the Newsletter link.

For Orthopaedics in Motion – Volume 1, Number 2 – Summer 2011 please visit The Disaster Preparedness Toolbox and click the Newsletter link.

For Orthopaedics in Motion – Volume 1, Number 1 – Spring 2011 please visit The Disaster Preparedness Toolbox and click the Newsletter link.

Open Subtrochanteric Femur Fracture – Part 1 Now Live

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Kamal, a healthy 20-year-old Afghan male, got caught in cross fire after an improvised explosive device (IED) detonated in his neighborhood. He was brought to a level II field hospital in Southeastern Afghanistan with a gun shot wound through his right anterolateral thigh and multiple exit wounds in his right buttock. Amazingly, Kamal is neurovascularly intact. Although there is an exit wound near his rectum, it does not penetrate it. Kamal is hemodynamically stable and has no other injuries.

Subtrochanteric Femur Fracture Image 1Subtrochanteric Femur Fracture Image 2Subtrochanteric Femur Fracture Image 3

Radiographs show a segmentally comminuted subtrochantric femur fracture.  The fracture includes some of the anterior cortex at the level of the lesser trochanter.

Subtrochanteric Femur Fracture Image 4Subtrochanteric Femur Fracture Image 5

General surgery clears him of a rectal injury and irrigates and debrides his right buttock of secondary shrapnel.

Subtrochanteric Femur Fracture Image 6Subtrochanteric Femur Fracture Image 7

When I saw Kamal, I had the brief thought that would be nice to call in the rep for a trochanteric entry third generation cephalomedullary nail. Then I remembered I was Afghanistan.

What would you suggest as the next steps in treatment in this less than ideal environment?