A 60yr male, DM & HTN for last 3yrs, on S-Numlo 5mg & Glycomet GP2 OD had a fall from bike and the bike fell on his Rt thigh. X-ray thigh attached. Suggest plan of management.

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Communicated #lower 1/3rd of rt femur three fragments one fragment separated or dislodgedand rest two are also dislocated but are in position. Since pt is hypertensive and diabetic so first step is to assess his clinical status. Since #femur a big bone and highly vasculerised bone in body causes huge bleeding hence first look at blood loss and if in shock or hypovolumic infuse BT.second stabilise his bp before taking to ot third thing control of bsl if pt is not on insulin than shift him on insulin once bsl and condition is in control give him thomas splint or traction and reduce the swelling. Once every thing in control take the pt to OT. Plans may be close reduction and nailing or open reduction and nailing or plating with bone graft if gap is bigger one just to assure good healing with Without shortening of limb. As failure rate is quite high ie too in diabetic so proper plan with expertise and good teem including physio will assure you successful

Thanx dr Mohd Aftab Husain
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Sir open or closed #?first approach a good control on DM then plan for surgery. If closed # nd soft tissue condition is good then orif by distal femur lateral lcp or Retrograde nailing w encerclage wiring .if open then adv for external fxn nd waiting for good skin condition

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Plan closed supracondylar nailing Bone graft later Opening the fracture site and getting anatomical reduction will compromise soft tissues and vascularity. Long bridging plate and lag screws for larger fragments another option.

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Stop OHA and shift to insulin and ensure proper glycemic control. Put the patient on a traction after stabilizing the fractured limb. Connect warm RL iv. IV Paracetamol will releive pain to a great extent. Open reduction and internal fixation to be planned after all investigations are available.

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Communicated # femur Rt. Fixation of femur by nail and thigh to be fixed for 6 to8 weeks.

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Investigate or cbc BSR serum creatine Hiv 1 2 HPBAG serum electrolyte HbA1c ECG ECHO if every thing ok Then plan treatment Fixation of femur with screw and nail

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HE WILL REQUIRE OPEN REDUCTION AND INTERNAL FIXATION AS IT IS A COMMUNUTED FRACTURE. BONE DENSITY IS FINE.

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Open redution internal fixation with k wiring

Retrograde nailing

Open reduction , interfragmentary compression , long lower femoral plate. Minimum 8 vortices above the fractre. Build up the Hb , intialy apply upper tibial skeletal traction, get the fragments aligned and get the length , fixation would be easier

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