00:01
Let's move on to a potential
traumatic femoral neck fracture.
00:06
Long bone fractures can be deadly,
particularly in elderly patients.
00:12
Generally speaking,
femoral neck fractures occur
when the patient falls on the lateral hip.
00:19
There's also usually assisted –
associated twisted mechanism
where the foot is stuck,
but the body is actually twisting.
00:28
On physical examination,
there may be obvious deformities,
such as external rotation
or a shortened extremity.
00:36
Remember,
don't over-manipulate these
on physical examination.
00:40
Sometimes,
when the external injury is not obvious,
patients often complain of groin pain,
especially on weight-bearing.
00:49
And remember,
particularly in traumatic situations,
this may be open.
00:54
In other words,
the skin overlying the fracture is actually lacerated.
01:00
These require urgent debridement
because the joint can become infected.
01:07
Here's an image.
01:08
It’s quite classic of a proximal
femoral neck fracture.
01:12
You notice –
you notice that the acetabulum in
the femoral head is intact.
01:16
However, the proximal femur
is now fractured.
01:23
These generally require surgery.
01:26
It usually requires
ORIF (open reduction internal fixation).
01:33
If your patient is extremely elderly,
bedridden or very debilitated,
remember,
an open reduction and internal fixation
of any major joint is a very,
very complex procedure
and associated oftentimes with
significant blood loss.
01:49
If your patient is already bedbound
or severely debilitated,
there's always the option
of non-operative management.
01:57
Here are some post-reduction films.
01:59
Clearly, you notice after the ORIF,
the alignment looks great.
02:05
Very important concept.
02:06
Hope you're paying attention.
02:08
Fat embolism is associated
with long bone fractures.
02:12
In fact, on a clinical scenario,
when you're presented with
a posttraumatic patient,
with this constellation of symptoms,
think fat embolism.
02:22
Let's review.
02:23
They include neurological abnormalities,
altered mental status, for example,
a classic petechial rash all over the body
and variable hypoxia.
02:36
In fact, oftentimes,
fat embolism patients are suspected
of having a pulmonary embolism.
02:44
The etiology of fat embolism
is not completely understood.
02:49
There's maybe introduction of fat globules
into the systemic circulation
when the bone is actually fractured.
02:57
Additionally,
we think that there is an inflammatory
process that leads to free fatty acids.
03:02
The jury is still out.
03:07
The management of fat embolism
is high index of suspicion
and mostly supportive.
03:12
We want to treat the hypoxia
and the patient may require ventilator assistance
if hypoxia is profound or worsening.