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首页> 美国卫生研究院文献>The Pan African Medical Journal >Knee megaprosthesis: a salvage solution for severe open and complex distal femoral fracture associated with an ipsilateral brachial plexus injury (a case report with literature review)
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Knee megaprosthesis: a salvage solution for severe open and complex distal femoral fracture associated with an ipsilateral brachial plexus injury (a case report with literature review)

机译：膝关节假体修复：严重的开放性复杂股骨远端骨折伴同侧臂丛神经损伤的抢救解决方案（文献复习病例报告）

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摘要

Complex distal femoral fractures in the young patient often occur as a result of high velocity trauma. Timely recognition and treatment is everything in such a situation, and it needs a robust staged management pathway to optimize the chance of limb preservation. We report a case of a motorcyclist admitted to the department of orthopedics at Chambery hospital, France, with a complex comminuted and open distal femoral fracture of the left leg, associated with a brachial plexus injury to the ipsilateral upper limb. On arrival to the emergency department, damage control stabilization and surgery was commenced, debridement of contaminated non-viable tissue, abundant antiseptic lavage and application of external fixation coupled with the use of antibiotic spacer. Following normalization of inflammatory markers and ensuring no clinical signs of infection, subsequent management consisted of joint reconstruction to achieve a functional knee. The external fixator and femoral spacer was removed and a modular megaprosthesis was implanted with a lateral gastrocnemius flap to cover the exposed knee joint and reinforce the extensor apparatus. Nerve graft to the left brachial plexus injury was performed at University Hospital of Grenoble. Our patient entered an intensive rehabilitation program and at 1 year follow-up achieved good knee function and sensation to the left upper limb.
机译：由于高速创伤，年轻患者中经常发生复杂的股骨远端骨折。在这种情况下，及时的识别和治疗至关重要，它需要一个稳健的分阶段管理途径来优化肢体保存的机会。我们报告一例摩托车骑师入法国尚贝里医院骨科的病例，左腿远端粉碎性粉碎性开放股骨远端骨折，伴有同侧上肢臂丛神经损伤。到达急诊室后，便开始进行稳定的损害控制和手术，清除受污染的不活组织的清创术，大量的消毒灌洗液以及使用外固定架以及使用抗生素垫片。在炎症标记正常化并确保没有感染的临床征兆之后，随后的治疗包括关节重建以实现功能性膝关节。移除外固定器和股骨垫片，并向模块化大假体植入腓肠肌外侧皮瓣，以覆盖裸露的膝关节并加固伸肌装置。在格勒诺布尔大学医院对左臂丛神经进行了神经移植。我们的患者进入了强化康复计划，并在1年的随访中获得了良好的膝盖功能和对左上肢的感觉。

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