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Intramedulläre Stabilisierung beidseitiger Femurfrakturen bei Polytrauma mit primärer Lungenembolie

Intramedullary stabilization of bilateral femur fractures with pulmonary artery embolism

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Zusammenfassung

Wir berichten über einen 31-jährigen Motorradfahrer, der mit schweren Verletzungen und einem ISS-Score von 38 in unsere Notfallabteilung eingeliefert wurde. Es lagen Knochenbrüche an allen 4 Extremitäten vor, Frakturen beider Oberschenkel, beider Radii, ein Weichteildecollement des rechten Unterschenkels, eine stabile BWK-9 und -10-Fraktur und eine zentrale Lungenarterienembolie. Nach Abwägung der Vor- und Nachteile wurde dem Patienten perkutan von distal durch die linke Vena femoralis ein Vena-cava-Schirm implantiert und unter kontinuierlichem Monitoring mittels transösophagealer Echokardiographie die beidseitigen Femurfrakturen mit Marknagelosteosynthesen versorgt. Der V.-cava-Schirm konnte 2 Tage postoperativ ohne Komplikationen entfernt. Der Patient wurde 2 Tage postoperativ extubiert, verbrachte 9 Tage auf der Intensivstation und konnte nach 28 Tagen in gutem Allgemeinzustand in die stationäre Rehabilitation entlassen werden.

Abstract

This is a case report of a 31-year-old motorcyclist who was admitted to our emergency department with severe multiple injuries and an ISS score of 38 points.

There were bone injuries on all 4 extremities, fractures of both proximal femurs, both radii, a great soft tissue injury of the lower limb, stable fractures of the spine and a blunt thoracic injury. A bone fragment compressed femoral vein and artery on the right side with consecutive thrombus in the inferior caval vein and thrombembolism of the central lung artery. The proximal femur fractures were treated initialy with γ-nails after implanting a cava-filter because of the high-risk constellation for further thrombembolism. Operation was monitored with transesophageal echocardiography.

The cava filter could be delivered on 2nd postoperative day without complication. The patient was ventilated for 1 day, stayed on ICU for 9 days and left hospital in a good condition after 28 days. It was the strategic and logistic great achievement of an interdisciplinary trauma center to implant cava filter and decide for intramedullar osteosythesis without delay.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie, Universitätsklinik Essen, Hufelandstraße 55, 45117, Essen, Deutschland

    U. Hamsen & D. Nast-Kolb

  2. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinik Gießen und Marburg, Marburg, Deutschland

    C.A. Kühne & S. Ruchholtz

  3. Klinik für Angiologie, Universitätsklinik Essen, Essen, Deutschland

    K. Kröger

Authors
  1. U. Hamsen
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  2. C.A. Kühne
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  3. K. Kröger
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  4. D. Nast-Kolb
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  5. S. Ruchholtz
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Correspondence to U. Hamsen.

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Hamsen, U., Kühne, C., Kröger, K. et al. Intramedulläre Stabilisierung beidseitiger Femurfrakturen bei Polytrauma mit primärer Lungenembolie. Chirurg 80, 969–973 (2009). https://doi.org/10.1007/s00104-009-1753-5

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  • DOI: https://doi.org/10.1007/s00104-009-1753-5

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