الأربعاء، 11 مارس 2009

case 13


Male patient presented with fracture shaft of both tibia and fibula .reduction & fixation was done by pop cast .later on the next mornoing he experienced severe pain and tingling in his foot and tightness in his leg after initial improvement.the cast was removed and his leg was covered by haemorrhagic bullae as in the photo.the preripheral pulse is palpable but pale extremeties with painful foot movement



the diagnosis may be choose
acute osteomyelitis
compartment syndrome
crush syndrome
fat embolism
to confirm the previous diagnosis choose
1retrograde after fasciotomy
2muscle enzymes
3measuring intracompartmental pressure
4abscent peripheral pulsation
5non of the above
as amanagement of fracture tibia and fibula all except choose
external fixation
skin graft
intramedullary nail
plate and screws for the fibula

هناك 6 تعليقات:

shady gad يقول...

بسم الله الرحمن الرحيم
الحاله حقيقيه وشفناها فى المرور بس للاسف ما صورتهاش والصور دى من على النت بس مطابقه للحاله تماما

غير معرف يقول...

بسم الله

الحالة
compartmental synd

بس اعتقد انه النبض لازم يكون ابسنت بسبب الضغط على الشرايين

non of above

skin graft
الا لو كانت حالة اوبن

تقبل تحياتي

وبانتظار المزيد لاننا استفدنا حقيقة

دمتم

dina يقول...

اممممممممم
مش عارفه انا شاكه انها تكون
acute .o
بس ممكن يكون حصل
compartmental.synd

2.non of the above
3.skin graft

وربنا يشفيه

د/عرفه يقول...

انا رايى
من رأى الدكتوره دينا
ربنا يشفيه
اكيد الراجل ده تعباناوى
اعمله حاجه يا شادى انت واقف تتفرج
ههههههههههههههههه

Ramy Seada يقول...

أنا شايف إنها
compartmental syndrome
وبعدين يا عم شادى مش قادر أعرف موقفك من
pulse
هو ضعيف ولا مش موجود
عموما مش هنختلف عشان انت صاحبى وحبيبى وكفاءة
السؤال التانى
measuring intracompartmental pressure
or
non of the above

السؤال الثالث
plate & screw for fibula

طبعا بقى لو فيه جوايز إبقى ادينى رنة
بس بجد حالاتك جامدة ودايما بستفيد
إلى الأمام دائما
تحياتى

shady gad يقول...

بسم الله الرحمن الرحيم
the case is compartmental syndrome
compartmental syndrome ocuurs in muscle compartments of leg and forearm due to acute or chronic ischemia .in this case it is due to haematoma after the fracture causing variable degree of pressure on veins,arteries and nerves.cs is characterized by pallor ,pain,tightness and difficult extention of affected
muscle compartment
acute osteomyelitis is not characterized by the same c/p
to diagnose cs itracompartmental pressure should be measured and fasciotomy is indicated if it is 30 mlhg less than diastolic pressure
in tanta it is mainly diagnosed clinically and dupplex may be helpful
muscle enzymes will be elevated but not diagnostic
abscent pulse is alate manifestation in cs and not diagnostic in early cases but it may disappear early in case of acute vascular injury after fracture but not cs
finally to manage acase of fracture tibia and fibula which is often an open fracture all will be indicated except plate and screw for fibula
fibula usually not fixed .surgeons usually fix tibia only and sometimes they fracture tibia and leave it fractured for grafting of any other bone as its function is only ms attachment
skin grafting will promote healing of skin and avoiding infection so it is indicated
thank you all