抄録
We report a case of multiple fractures in an ipsilateral lower extremity that presented treatment difficulties resulting from delayed femoral union, skin necrosis, and MRSA infection. The patient was 28-year-old woman with a trochanteric fracture of the left femur (AO classification 31-A1), a shaft fracture of the left femur (AO classification 32-A3), open fractures of the left tibia and fibula (AO classification tibia 42-A3 and fibula 42-A2), and dislocation of the right 4th toe MP joint, all as a result of a traffic accident.
On the day of admission, a surgical procedure was performed, which included debridement and external fixation for the open fractures of the left tibia and fibula. Five days after the first operation, osteosynthesis of the left femoral shaft fracture was carried out using a Gamma 3 long trochanteric nail, but the distal locking screw could not be inserted because of obesity and swelling of the left thigh. Thereafter, MRSA infection and skin necrosis occurred at the open wound associated with the left tibia and fibula. After these skin problems had been resolved, insertion of an intramedullary nail for the tibia fracture and plate fixation for the fibula fracture were performed at 5 months after injury. A period of about 8.5 months was required before the patient was able to walk with full weight-bearing.
There were several reasons why this case took such a long time to treat, and these included the double fracture of the femur, a situation referred to as “floating knee”, soft tissue damage and the surgical technique employed.
