TRETMAN PIPKIN TIP IV FRAKTURE-LUKSACIJE UDRUŽENE ZA HEMATOMOM, ZNAČAJNOM MEKOTKIVNOM POVREDOM I DUBOKOM INFEKCIJOM − PRIKAZ SLUCAJA
Sažetak
Frakture glave femura povezane sa frakturama acetabuluma predstavljaju nesvakidašnje povrede koje su rezultat visokoenergetskog mehanizma. Ovaj rad ima za cilj da prezentuje uspešan operativni tretman Pipkin tip IV frakture, kominutivne frakture glave femura povezane sa hematomom, povredom mekih tkiva i dubokom infekcijom.
Bolesnik D.M. rođen 1976 godine povređen je betonskim blokovima. Bolesnik je politraumatizovan sa traumatskim šokom i Pipkin IV dislociranom i kominutivnom frakturom leve femoralne glave, uz kominutivnu frakturu acetabuluma i sa velikim hematomom leve femoralne regije, kao i sa mekotkivnim oštečenjem. Bolesnik je imao frakturu pubične i išijadične kosti sa desne strane karlice. Bio je odmah primljen u jedinicu intenzivne nege, kao hitan slučaj.
Prvo, izveli smo otvorenu repoziciju i unutrašnju fiksaciju levog acetabuluma sa pločom i šrafovima. Onda je bolesnik dobio ozbiljnu infekciju hematoma leve femoralne regije, zbog čega smo morali da tretiramo infekciju u naredna dva meseca. Bili smo primorani da čekamo tri meseca, kako bi utvrdili da nema bilo kakvih znakova infekcije (nivoa CRP u normali) i onda smo postavili subtotalnu protezu, nakon što smo izvadili fragmente glave femura.
Bolesnik nije imao nikakve znakove infekcije nakon drugog operativnog tretmana i odlučili smo da je vreme da započne intenzivnu fizikalnu terapiju u trajanju od tri meseca. Mogao se kretati bez bilo kakvih pomagala nakon tri meseca od završenog operativnog tretmana i završene fizikalne terapije, uz mala ograničenja u pokretima.
Uradili smo radiološku kontrolu godinu dana nakon operacije, koja je pokazala ektopičnu osifikaciju, ali bez bilo kakvih zabrinjavajućih ograničenja u pokretima. Harris hip score u tom periodu bio je 81.
Glavni tretman uvek bi trebao biti usmeren ka momentalnoj anatomskoj redukciji fragmenata sa minimalnim oštećenjem mekih tkiva i fiksaciji uz ORIF u slučajevima svih ostalih tipova Pipkin fraktura, ali u slučajevima Pipkin IV frakture povezane sa prethodno masivnim ostećenjem mekih tkiva i dubokom infekcijom mi preporučujemo da se sačeka druga po redu opertivna intervencija, bar tri meseca od prestanka simptoma infekcije.
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