scholarly journals “Management of Femur Shaft Fracture with Nancy Nail in the Setting of Dystrophic Epidermolysis Bullosa”: A case report

Author(s):  
Mohammed Mamdouh Tarabishi ◽  
Shahd Almonaie ◽  
Mohamed Taha Abdelaty Mohamed ◽  
Weam Farid Mousa

Abstract BackgroundThe management of bone fractures must achieve both the reduction and stability providence. However, dermatological conditions such as dystrophic epidermolysis bullosa (DEB) for instance can lead to catastrophic events when operating on the patient’s bone fracture. This can lead to wound infections and possible failure of bone healing leading to fracture nonunion. This dermatological disorder leads to heterogenous bullous dermatoses including cutaneous fragility leading to cutaneous bullous formation after exposure to any type of trauma. DEB is a rare inherited form of the disease characterized by the formation of cutaneous bullae. DEB is associated with a genetic mutation of COL7A1 gene that encodes collagen type VII. Due to the rarity and uniqueness of the disease, special modifications due to the challenges faced during the patient care approach were accomplished to prevent any possible harm to the patient. In this study, we propose a case report that is followed by the anesthetic and surgical challenges faced and how they were modified upon.Case PresentationA 20-year-old female presented to the emergency department with a spiral mid-diaphyseal fracture of the femur after an incidence of falling from bed. The patient was previously diagnosed with dystrophic epidermolysis bullosa which made this case unique and complex. As the patient was examined by the team, her skin was covered with old blisters and wounds that have developed with the consequence of the disease. Due to the sophisticated dermatological condition and the unique presentation, the established multidisciplinary team took a decision to treat the patient with flexible intramedullary nailing in an open versus closed reduction technique, and modifications of the treatment approach were done based on the challenges in this case. The goal was to provide the management while minimizing the risk of infections and complications that would have arisen. The proposed case will set a baseline for the management of similar cases.ConclusionsWe suggest that in order to manage femur shaft fracture in the setting of dystrophic epidermolysis bullosa, modifying the management to avoid the least possible skin harm at any expense while managing the bone fracture is the golden approach.

2015 ◽  
Vol 16 ◽  
pp. 711-714 ◽  
Author(s):  
Uday Guled ◽  
Vijay G. Goni ◽  
Arjun R.H. Honnurappa ◽  
Rakesh John ◽  
Harsha Vardhana ◽  
...  

2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Etienne Boyer ◽  
Gauthier Menu ◽  
Thomas Rondot ◽  
Fanny Mille ◽  
Maxime Ferrier ◽  
...  

2020 ◽  
Author(s):  
Tayyar Kürşat Dabak ◽  
Osman Ci̇van ◽  
Hakan Özdemi̇r

Abstract Background: Limited data is available regarding the effect of gap size, fragment size and position of fragment on union in fragmented femur shaft fracture. The aim of the study is to analyze the effect of these parameters on union and determine cut-off values that necessitate reduction of fragment. Methods: Total of 59 patients with fragmented femur shaft fracture were reviewed and the effect of fragment size, gap size and fragment position on union were evaluated on 3rd, 6th and 12th month graphies from medical record of patients. Union rate was determined due to Radiographic Union Score of Femur. Patients were divided into small gap ( 10 mm) or large gap (10 mm), reverse fragment or non-reverse fragment and small fragment (50 mm) or large fragment (50mm) groups. Kruskal–Wallis Variance Analysis and Mann Whitney U test was used for comparisons among groups. The post-hoc Mann Whitney U-Test with Bonferroni Correction was used when the Kruskal Wallis Variance Analysis determined a significant difference.Results: In comparison of union scores of groups in regarding gap size and fragment size, there was not significant difference between groups at 3rd, 6th and 12th months. Union scores in the 3rd month (p=0,011) and 6th month (p=0,039) were lower in the reverse group than non-reverse group. But there was not statistically significant difference between two groups at 12th month (p=0.819). There was no significant difference in union rates in respect to intramedullary nail types. There was an indirect correlation between age and mean union score at 12th month. Conclusions: we could not determine any cutoff value regarding gap width and fragment size in the treatment of the femoral shaft fractures by IMN. Although there was a tendency to decrease in union scores due to the increase in the gap size, any significant difference was not determined. Only the reverse position of fragment had an adverse effect on the union until 6th months but the union score of reverse group reached the result of the non-reverse group by 12th months.


1989 ◽  
Vol 24 (3) ◽  
pp. 761
Author(s):  
Soo Kil Kim ◽  
Keung Bae Lee ◽  
Sae Jung Oh ◽  
Kye Seok Yang

2014 ◽  
Vol 27 (4) ◽  
pp. 287
Author(s):  
Jong-Hee Lee ◽  
Jong-Hoon Park ◽  
Si-Yeong Park ◽  
Seong-Cheol Park ◽  
Seung-Beom Han

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