Presentation on theme: "Case Examples – severe lower limb injuries"— Presentation transcript:
1 Case Examples – severe lower limb injuries March 2014Trauma ConferenceAndy GrayNewcastle Hospitals
2 Example 1 42 year old fit and well male RTA – 28th March 2013 (1 year ago!)Transferred to RVIA,B,C normal. GCS 15Pan CT scan – no significant injury to head, neck, thoracolumbar spine, chest, abdo etc
3 Secondary survey Bilateral distal femoral shaft fractures Left thigh woundBoth kneecaps damagedClassic ‘dashboard’ injuryHips and pelvis fineArterial line being inserted into wrist during secondary surveyOrtho trauma theatre free (consultant led)On call consultant going to fracture clinic
4 Theatre Stable patient / base excess OK (no acidosis) Debridement and irrigation of woundBilateral retrograde nailingLeft performed / supervised by consultant 1Right performed by consultant 2Transferred to ITU/HDU after surgery
13 Transferred to hospital closer to home As per national guidelinesCase discussed with receiving teamGood communicationPatient spent 1 week in hospital before requesting re-transfer back to RVI
14 Issues Receiving unit critical of care received No ownership of patient -no consultant reviewK wires removed from toe deformity recurredCritical of position of wrist plateCritical of missed screw“How old was your treating surgeon?”Worried and confused patient.
19 9 months after injury – femurs healed and doing well apart from toe!!
20 Issues for discussion Importance of repeating the secondary survey Repatriation of patientsIn theory everybody agrees with this? Dealing with complications? Patients need secondary proceduresOwnership of the patientAvoiding criticising treatment of patient‘I would have managed this differently’
21 Case 2- 35 year old male / MBA / isolated lower limb injury / 22 stone
27 Discussion points Expect the unexpected Importance of having allied specialties (plastics/vascular) available on-siteDevelopment of a gold standard regional service for open fractures and complex lower limb reconstruction