Challenge of the Week / Trauma / 06.11.2021

A 22-year-old female patient sustained bilateral femoral fractures while skiing. She is brought to the emergency department and receives fluids and blood products. Her vital signs are currently: blood pressure, 110/60 mm Hg; and heart rate, 133 beats/minute. Her base excess is -3. Which of the following is the best treatment for her orthopaedic injuries at this time?

    • External fixation of one femoral fracture and intramedullary fixation of the contralateral femoral fracture
    • The patient is hemodynamically unstable and would not be a candidate for definitive management of even one of her fractures at this time.

 

    • Intramedullary fixation of both femoral fractures
    • Intramedullary nailing of both femoral fractures may be indicated once the patient has been successfully resuscitated and stabilized. At this point, definitive fixation would place the patient at risk for acute respiratory distress syndrome and multisystem organ failure.

 

    • External fixation of both femurs with operative treatment once the patient is stable
    • The patient has signs of hemodynamic instability and underperfusion. At this time, initiation of damage-control orthopaedics with external fixation of both femoral fractures to stabilize the fractures as much as possible is indicated.

 

    • Open reduction and internal fixation of both femoral fractures
    • Open reduction and internal fixation of both femoral fractures may be indicated once the patient has been successfully resuscitated and stabilized. At this point, definitive fixation would place the patient at risk for acute respiratory distress syndrome and multisystem organ failure.

     

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