PDF(Pubmed)
Abstract：
A 35-year old healthy male trauma surgery chief resident, suffered a high-speed motor vehicle collision. The patient sustained the following injuries: a Gustilo-Anderson grade 2 open comminuted intra-articular fracture of the left distal femur (AO 33C3.3), a Hawkins 1A neck fracture of the right talus (AO 81.2A), an undisplaced Lisfranc injury of the right foot comprising avulsion fractures at the base of the 1st, 2nd and 5th metatarsal as well as the cuboid bone suggesting ligament injury and 2nd to 5th carpometacarpal dislocations of the right (non-dominant) hand with comminuted fractures of the capitate, hamate, trapezoid and the base of the fifth metacarpal bone. A staged-treatment approach ensued. An external fixator (ex-fix) was placed over the left knee, followed by definitive fixation of the distal femoral fracture using a Qwix screw, Non-Contact Bridging (NCB) plate and Locking Compression Plate (LCP). An ex-fix was placed over the right wrist, followed by open reduction and k-wire fixation. The talar fracture of the right foot was treated with a single lag screw and the Lisfranc injury was treated non-operatively with four weeks of non-weight bearing cast immobilization. An intensive clinical rehabilitation program was started, including early use of Continuous Passive Motion (CPM), daily non-weightbearing swimming pool exercises, hand, physical and recreational therapy. One year after the injury the patient was rehabilitated and resumed his surgical residency. Two years after the injury, limited flexion and pain in the left leg remains, possibly related to partial union of the femoral fracture. Range of motion (ROM) of the right ankle and wrist remains limited, not causing significant functional impairment. Lessons learned from a patient experience combined with detailed descriptions of injuries, rehabilitation and long term outcomes can be used as a reference for treating patients with comparable injuries.
摘要：
一名35岁健康的男性外伤手术总住院医师,汽车发生高速碰撞。患者遭受以下伤害：左股骨远端Gustilo-Anderson2级开放性粉碎性关节内骨折（AO33C3.3），右距骨Hawkins1A颈骨折（AO81.2A），右脚未移位的Lisfranc损伤，包括1号底部的撕脱性骨折，第2和第5meta骨以及长方体骨提示右手（非优势手）韧带损伤和第2至第5腕掌脱位伴头骨粉碎性骨折，Hamate,梯形和第五掌骨的基部。随后出现了分阶段治疗方法。将外部固定器（前固定）放置在左膝盖上，随后使用Qwix螺钉确定固定股骨远端骨折，非接触桥接（NCB）板和锁定压缩板（LCP）。右手腕上放了一个前修，其次是切开复位和k线固定。右脚距骨骨折用单个拉力螺钉治疗，Lisfranc损伤非手术治疗，非负重石膏固定四周。开始了一项密集的临床康复计划，包括早期使用连续被动运动(CPM)，每日非负重游泳池练习，手,物理和娱乐治疗。受伤一年后，患者康复并恢复了手术治疗。受伤两年后，左腿仍然有限的屈曲和疼痛，可能与股骨骨折的部分愈合有关。右脚踝和手腕的活动范围（ROM）仍然有限，不会导致明显的功能损害。从患者的经验中汲取的经验教训以及对伤害的详细描述，康复和长期结果可作为治疗具有可比性损伤的患者的参考.
