Let's move on to a potential
traumatic femoral neck fracture.
Long bone fractures can be deadly,
particularly in elderly patients.
femoral neck fractures occur
when the patient falls on the lateral hip.
There's also usually assisted –
associated twisted mechanism
where the foot is stuck,
but the body is actually twisting.
On physical examination,
there may be obvious deformities,
such as external rotation
or a shortened extremity.
don't over-manipulate these
on physical examination.
when the external injury is not obvious,
patients often complain of groin pain,
especially on weight-bearing.
particularly in traumatic situations,
this may be open.
In other words,
the skin overlying the fracture is actually lacerated.
These require urgent debridement
because the joint can become infected.
Here's an image.
It’s quite classic of a proximal
femoral neck fracture.
You notice –
you notice that the acetabulum in
the femoral head is intact.
However, the proximal femur
is now fractured.
These generally require surgery.
It usually requires
ORIF (open reduction internal fixation).
If your patient is extremely elderly,
bedridden or very debilitated,
an open reduction and internal fixation
of any major joint is a very,
very complex procedure
and associated oftentimes with
significant blood loss.
If your patient is already bedbound
or severely debilitated,
there's always the option
of non-operative management.
Here are some post-reduction films.
Clearly, you notice after the ORIF,
the alignment looks great.
Very important concept.
Hope you're paying attention.
Fat embolism is associated
with long bone fractures.
In fact, on a clinical scenario,
when you're presented with
a posttraumatic patient,
with this constellation of symptoms,
think fat embolism.
They include neurological abnormalities,
altered mental status, for example,
a classic petechial rash all over the body
and variable hypoxia.
In fact, oftentimes,
fat embolism patients are suspected
of having a pulmonary embolism.
The etiology of fat embolism
is not completely understood.
There's maybe introduction of fat globules
into the systemic circulation
when the bone is actually fractured.
we think that there is an inflammatory
process that leads to free fatty acids.
The jury is still out.
The management of fat embolism
is high index of suspicion
and mostly supportive.
We want to treat the hypoxia
and the patient may require ventilator assistance
if hypoxia is profound or worsening.