Presentation
High speed car crash.
Patient Data
There is a heavily comminuted fracture of the right femur, mid shaft. Significant posterior displacement can be seen on the lateral views.
Heavily comminuted fractrure of the mid diaphysis of the femur, with posterior displacement, there is a a sudden cutoff at the profunda femoris at the mid femur yet the SFA and the popliteal artery are normal. Subcutaneous air gives evidence of an open injury. Anterior compartment demonstrates an intramuscular hematoma.
The left medial patella is comminuted, with a significant soft tissue defect, the anterior portion of the medial aspect of the femoral condyle is also heavily communited.
Case Discussion
The presence of subcutaneous air raises high suspicion of an open or compound fracture. These fractures have a high rate of microbial contamination 1; this patient went immediately to operating theater for surgical decontamination and external fixation.