Distal third left femoral shaft fracture with arterial injury
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A 35-year-old woman was in a palm oil lorry accident that caused her left femoral shaft fracture and arterial injury. She presented with a cold, painful left leg with absent pulses. Exploration revealed an oblique femoral shaft fracture with partial femoral artery injury. The bone was plated and artery repaired with end-to-end anastomosis. Post-operatively, pulses returned and she showed great improvement. The case highlights that vascular injury can occur with femoral fractures and should be monitored for even in closed fractures.
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The document discusses factors that influence the selection of intravenous (IV) access size, specifically as it relates to fluid flow rates. It describes the physics of fluid flow through tubes using the Hagen-Pouseille equation. Key factors that determine flow rates are tube diameter, length, viscosity, and pressure gradient. Larger bore IV access and shorter lengths allow for higher flow rates. During resuscitation, larger peripheral IV sizes like 14-18 gauge or central lines are preferred over multi-lumen extensions or smaller gauge access due to higher flow capacities needed. Selection of IV access also considers compatibility with medications as well as patient age and size.
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Evidence based approach for the management of asthma in pregnancy
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Volkman ischamic contracture
Volkmann's contracture is a deformity of the hand, fingers, and wrist that occurs after trauma reduces blood flow to the forearm muscles. This leads to muscle shortening (contracture). The contracture typically involves the wrist flexors but can also affect extensors. Reduced blood flow is usually due to fractures near the elbow that block arteries. Physical therapy management focuses on passive stretching, range of motion exercises, splinting, and muscle strengthening to recover mobility and counteract the contracture.
Orthopedics 5th year, 7th/part two & 8th lectures (Dr. Ali A.Nabi)
Dislocation of the knee joint can be a serious injury, especially if there is damage to blood vessels which can lead to limb loss if missed. The knee can dislocate in various positions such as anteriorly, posteriorly, or medially/laterally. Over half of dislocations are anterior or posterior, which have a high risk of popliteal artery injury. Knee dislocations require reduction and splinting, followed by examination and imaging to check for injuries to ligaments, blood vessels, and nerves.
11. vascular disease
This document discusses peripheral arterial disease (PAD), which is usually caused by atherosclerosis and shares risk factors with coronary artery disease such as smoking, diabetes, hyperlipidemia, and hypertension. PAD can present as intermittent claudication (pain in the leg muscles brought on by walking) or critical limb ischemia (rest pain and tissue loss). Treatment depends on the severity and location of the disease. Other vascular conditions mentioned include aneurysms, arterial dissections, and various forms of arteritis.
Orthopedic surgery 6th injuries to the upper limb ( 3 )
This document discusses various orthopedic injuries and conditions involving the upper limb. It describes scaphoid bone fractures, including causes, signs and symptoms, diagnostic imaging, treatment options, and complications like avascular necrosis. It also discusses dislocations of the lunate bone, Kienböck's disease, fractures of the hook of hamate, metacarpals, and phalanges. Additional topics include Gamekeeper's thumb, De Quervain's tenosynovitis, trigger finger, and ganglion cysts. Flexor tendon injuries and healing are also summarized.
Case Report : closed fracture 1/3 middle left femur
A 16-year-old boy was admitted to the hospital after a traffic accident where he fell from a motorcycle. He reported pain in his left thigh. Examination found deformity, hematoma, and swelling of the left femur region with tenderness. X-rays showed a closed fracture of the middle third of the left femur. He was diagnosed and treated with open reduction internal fixation surgery.
Presentation1, radiological imaging of anterior knee pain.
This document discusses radiological imaging of anterior knee pain. It notes that knee MRI is the gold standard for evaluating damage to anatomical structures like ligaments, tendons, meniscus and cartilage. Common causes of anterior knee pain discussed include patellar fractures, osteoarthritis, tendinitis, dislocations and cartilage defects. Specific conditions like osteochondritis dissecans, fat pad syndromes, and bipartite/multipartite patella are described. MRI features of various pathologies are shown through images to aid radiologists in diagnosis.
Fractures
There are many types of bone fractures that can occur due to impacts, stress, or underlying medical conditions weakening the bones. A Colles' fracture is a break of the distal radius bone, often from a fall on an outstretched hand. A pathologic fracture results from diseases like osteoporosis weakening the bone structure. Stress fractures are small cracks in weight-bearing bones caused by repeated stress or impact from activities like running.
Orthopedics 5th year, 5th lecture (Dr. Ali A.Nabi)
The document discusses intertrochanteric fractures and subtrochanteric fractures of the femur. Intertrochanteric fractures most commonly occur in elderly osteoporotic women and usually involve a fall directly on the hip. They often heal easily without complications. Subtrochanteric fractures below the lesser trochanter typically result from high-energy trauma and can be difficult to heal due to the dense cortical bone in that region. Surgical treatment with internal fixation is now preferred for most intertrochanteric and subtrochanteric fractures to allow early mobilization and reduce complications compared to previous nonsurgical approaches.
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This document discusses skeletal changes seen in various blood disorders including thalassemia, sickle cell anemia, and hemophilia. Thalassemia causes bone marrow expansion leading to osteoporosis, cortical thinning, and bone deformities. Sickle cell anemia results in bone infarcts, osteonecrosis, and vertebral endplate abnormalities. Hemophilia produces joint hemorrhages, pseudo-tumors, osteoporosis, and eventual joint destruction. Radiographs are useful for identifying characteristic findings in these inherited bleeding and hemolytic disorders.
Arterial_thrombosis_and_embolism-1.pdf
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2. It outlines the educational objectives which are to teach students to recognize symptoms, differentiate embolism and thrombosis, determine locations of vascular lesions, choose surgical methods, and conduct conservative therapy.
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This document provides information about fractures seen in radiology. It defines a fracture and lists common causes. It describes signs and symptoms of fractures and provides an approach to describing fractures seen on radiographs. It details different types of fractures including complete, incomplete, open/compound, pathologic, and stress fractures. It then describes fractures seen in various locations of the lower extremities such as the femur, knee, ankle, foot, and calcaneus. It provides classifications for certain fractures like tibial plateau and ACL avulsion fractures.
Bohomolets Surgery 4th year Lecture #10
Chronic lower limb arterial disease is commonly caused by atherosclerosis and presents as intermittent claudication (IC) or critical limb ischemia (CLI). IC involves pain in the calf on walking that resolves with rest, while CLI includes tissue loss and gangrene. Treatment focuses on risk factor modification and exercise, with revascularization considered if best medical therapy fails. Endovascular procedures and bypass surgery aim to restore blood flow and relieve symptoms. Amputation may be necessary in advanced CLI if revascularization is not possible.
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This document discusses fracture management in elderly patients. It covers common fractures seen in elderly including vertebral fractures, distal radius fractures, hip fractures including femoral neck and intertrochanteric fractures. For each fracture, it discusses etiology, clinical features, investigations, treatment options and complications. Surgical treatment is preferred for displaced fractures to allow early mobilization and prevent complications of bed rest.
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Ganyang MCQ Ortho Answers
A supracondylar fracture occurs just above the elbow joint and is one of the most common fractures in children. It can cause complications like compartment syndrome if the brachial artery is damaged. A Colles' fracture is a break of the radius bone in the forearm near the wrist, causing the "dinner fork" deformity. Fractures of the femoral neck mainly occur in older people with osteoporosis and are classified by the Garden system. Compartment syndrome results from increased pressure in an enclosed muscle space, causing pain, numbness and possible tissue death.
Fractures of MSK
This document defines and describes fractures, their causes, symptoms, types, and complications. A fracture is a break in the structural continuity of the bone that can be painful. Fractures are caused by trauma, stress/fatigue, or pathological disorders. Symptoms include swelling, deformity, pain with movement, loss of function, and bone protruding in compound fractures. Hip fractures specifically are most common in the elderly from falls, and include intracapsular, intertrochanteric, and subtrochanteric types based on the location of the break. Complications of fractures can include blood loss, injury to surrounding tissues, stunted bone growth in children, respiratory issues, blood clots, and infections.
Arterial arterial occlusion
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Orthopedic surgery 6th injuries to the upper limb ( 3 )
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Osce post op management for lscs
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This document provides guidance on conducting an effective history taking for internal medicine postings. It outlines the key sections to cover, including identification data, chief complaints, history of present illness, past medical history, social history, and others. For each section, it describes the essential information to obtain, such as relevant symptoms and their progression, past and current medical issues, medication usage, lifestyle and family factors. The document emphasizes a structured yet flexible approach, using open-ended questioning followed by focused questions, to fully understand the patient's condition and identify potential diagnoses.
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留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
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Morgan Freeman is Jimi Hendrix: Unveiling the Intriguing Hypothesis
In celebrity mysteries and urban legends. Few narratives capture the imagination as the hypothesis that Morgan Freeman is Jimi Hendrix. This fascinating theory posits that the iconic actor and the legendary guitarist are, in fact, the same person. While this might seem like a far-fetched notion at first glance. a deeper exploration reveals a rich tapestry of coincidences, speculative connections. and a surprising alignment of life events fueling this captivating hypothesis.
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Introduction to the Hypothesis: Morgan Freeman is Jimi Hendrix
The idea that Morgan Freeman is Jimi Hendrix stems from a mix of historical anomalies, physical resemblances. and a penchant for myth-making that surrounds celebrities. While Jimi Hendrix's official death in 1970 is well-documented. some theorists suggest that Hendrix did not die but instead reinvented himself as Morgan Freeman. a man who would become one of Hollywood's most revered actors. This article aims to delve into the various aspects of this hypothesis. examining its origins, the supporting arguments. and the cultural impact of such a theory.
The Genesis of the Theory
Early Life Parallels
The hypothesis that Morgan Freeman is Jimi Hendrix begins by comparing their early lives. Jimi Hendrix, born Johnny Allen Hendrix in Seattle, Washington, on November 27, 1942. and Morgan Freeman, born on June 1, 1937, in Memphis, Tennessee, have lived very different lives. But, proponents of the theory suggest that the five-year age difference is negligible and point to Freeman's late start in his acting career as evidence of a life lived before under a different identity.
The Disappearance and Reappearance
Jimi Hendrix's death in 1970 at the age of 27 is a well-documented event. But, theorists argue that Hendrix's death staged. and he reemerged as Morgan Freeman. They highlight Freeman's rise to prominence in the early 1970s. coinciding with Hendrix's supposed death. Freeman's first significant acting role came in 1971 on the children's television show "The Electric Company," a mere year after Hendrix's passing.
Physical Resemblances
Facial Structure and Features
One of the most compelling arguments for the hypothesis that Morgan Freeman is Jimi Hendrix lies in the physical resemblance between the two men. Analyzing photographs, proponents point out similarities in facial structure. particularly the cheekbones and jawline. Both men have a distinctive gap between their front teeth. which is rare and often highlighted as a critical point of similarity.
Voice and Mannerisms
Supporters of the theory also draw attention to the similarities in their voices. Jimi Hendrix known for his smooth, distinctive speaking voice. which, according to some, resembles Morgan Freeman's iconic, deep, and soothing voice. Additionally, both men share certain mannerisms. such as their calm demeanor and eloquent speech patterns.
Artistic Parallels
Musical and Acting Talents
Jimi Hendrix was regarded as one of t
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校徽：象征着学校的荣誉和传承。
校名:学校英文全称
授予学位：本部分将注明获得的具体学位名称。
毕业生姓名：这是最重要的信息之一，标志着该证书是由特定人员获得的。
颁发日期：这是毕业正式生效的时间，也代表着毕业生学业的结束。
其他信息：根据不同的专业和学位，可能会有一些特定的信息或章节。
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The Evolution and Impact of Tom Cruise Long Hair
Tom Cruise is one of Hollywood's most iconic figures, known for his versatility, charisma, and dedication to his craft. Over the decades, his appearance has been almost as dynamic as his filmography, with one aspect often drawing significant attention: his hair. In particular, Tom Cruise long hair has become a defining feature in various phases of his career. symbolizing different roles and adding layers to his on-screen characters. This article delves into the evolution of Tom Cruise long hair, its impact on his roles. and its influence on popular culture.
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Introduction
Tom Cruise long hair has often been more than a style choice. it has been a significant element of his persona both on and off the screen. From the tousled locks of the rebellious Maverick in "Top Gun" to the sleek, sophisticated mane in "Mission: Impossible II." Cruise's hair has played a pivotal role in shaping his image and the characters he portrays. This article explores the various stages of Tom Cruise long hair. Examining how this iconic look has evolved and influenced his career and broader fashion trends.
Early Days: The Emergence of a Style Icon
The 1980s: The Birth of a Star
In the early stages of his career during the 1980s, Tom Cruise sported a range of hairstyles. but in "Top Gun" (1986), his hair began to gain significant attention. Though not long by later standards, his hair in this film was longer than the military crew cuts associated with fighter pilots. adding a rebellious edge to his character, Pete "Maverick" Mitchell.
Risky Business: The Transition Begins
In "Risky Business" (1983). Tom Cruise's hair was short but longer than the clean-cut styles dominant at the time. This look complemented his role as a high school student stepping into adulthood. embodying a sense of youthful freedom and experimentation. It was a precursor to the more dramatic hair transformations in his career.
The 1990s: Experimentation and Iconic Roles
Far and Away: Embracing Length
One of the first films in which Tom Cruise embraced long hair was "Far and Away" (1992). Playing the role of Joseph. an Irish immigrant in 1890s America, Cruise's long, hair added authenticity to his character's rugged and determined persona. This look was a stark departure from his earlier. more polished styles and marked the beginning of a more adventurous phase in his hairstyle choices.
Interview with the Vampire: Gothic Elegance
In "Interview with the Vampire" (1994). Tom Cruise long hair reached new lengths of sophistication and elegance. Portraying the vampire Lestat. Cruise's flowing blonde locks were integral to the character's ethereal and timeless allure. This hairstyle not only suited the gothic aesthetic of the film but also showcased Cruise's ability to transform his appearance for a role.
Mission: Impossible II: The Pinnacle of Long Hair
One of the most memorable instances of Tom Cruise long hair came in "Mission: Impossible II" (2000). His character, Ethan
Sara Saffari: Turning Underweight into Fitness Success at 23
Uncover the remarkable journey of Sara Saffari, whose transformation from underweight struggles to being recognized as a fitness icon at 23 underscores the importance of perseverance, discipline, and embracing a healthy lifestyle.
Tom Cruise Daughter: An Insight into the Life of Suri Cruise
Tom Cruise is a name that resonates with global audiences for his iconic roles in blockbuster films and his dynamic presence in Hollywood. But, beyond his illustrious career, Tom Cruise's personal life. especially his relationship with his daughter has been a subject of public fascination and media scrutiny. This article delves deep into the life of Tom Cruise daughter, Suri Cruise. Exploring her upbringing, the influence of her parents, and her current life.
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Introduction: The Fame Surrounding Tom Cruise Daughter
Suri Cruise, the daughter of Tom Cruise and Katie Holmes, has been in the public eye since her birth on April 18, 2006. Thanks to the media's relentless coverage, the world watched her grow up. As the daughter of one of Hollywood's most renowned actors. Suri has had a unique upbringing marked by privilege and scrutiny. This article aims to provide a comprehensive overview of Suri Cruise's life. Her relationship with her parents, and her journey so far.
Early Life of Tom Cruise Daughter
Birth and Immediate Fame
Suri Cruise was born in Santa Monica, California. and from the moment she came into the world, she was thrust into the limelight. Her parents, Tom Cruise and Katie Holmes. Were one of Hollywood's most talked-about couples at the time. The birth of their daughter was a anticipated event. and Suri's first public appearance in Vanity Fair magazine set the tone for her life in the public eye.
The Impact of Celebrity Parents
Having celebrity parents like Tom Cruise and Katie Holmes comes with its own set of challenges and privileges. Suri Cruise's early life marked by a whirlwind of media attention. paparazzi, and public interest. Despite the constant spotlight. Her parents tried to provide her with an upbringing that was as normal as possible.
The Influence of Tom Cruise and Katie Holmes
Tom Cruise's Parenting Style
Tom Cruise known for his dedication and passion in both his professional and personal life. As a father, Cruise has described as loving and protective. His involvement in the Church of Scientology, but, has been a point of contention and has influenced his relationship with Suri. Cruise's commitment to Scientology has reported to be a significant factor in his and Holmes' divorce and his limited public interactions with Suri.
Katie Holmes' Role in Suri's Life
Katie Holmes has been Suri's primary caregiver since her separation from Tom Cruise in 2012. Holmes has provided a stable and grounded environment for her daughter. She moved to New York City with Suri to start a new chapter in their lives away from the intense scrutiny of Hollywood.
Suri Cruise: Growing Up in the Spotlight
Media Attention and Public Interest
From stylish outfits to everyday activities. Suri Cruise has been a favorite subject for tabloids and entertainment news. The constant media attention has shaped her childhood. Despite this, Suri has managed to maintain a level of normalcy, thanks to her mother's efforts.
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3:国家专业人才认证中心颁发入库证书
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5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
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办理(uw毕业证书)美国威斯康星大学麦迪逊分校毕业证【微信：741003700 】格式相对统一，各专业都有相应的模板。通常包括以下部分：
校徽：象征着学校的荣誉和传承。
校名:学校英文全称
授予学位：本部分将注明获得的具体学位名称。
毕业生姓名：这是最重要的信息之一，标志着该证书是由特定人员获得的。
颁发日期：这是毕业正式生效的时间，也代表着毕业生学业的结束。
其他信息：根据不同的专业和学位，可能会有一些特定的信息或章节。
办理(uw毕业证书)美国威斯康星大学麦迪逊分校毕业证【微信：741003700 】价值很高，需要妥善保管。一般来说，应放置在安全、干燥、防潮的地方，避免长时间暴露在阳光下。如需使用，最好使用复印件而不是原件，以免丢失。
综上所述，办理(uw毕业证书)美国威斯康星大学麦迪逊分校毕业证【微信：741003700 】是证明身份和学历的高价值文件。外观简单庄重，格式统一，包括重要的个人信息和发布日期。对持有人来说，妥善保管是非常重要的。
What Going to the Doctor is Like as an Adult Comics
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本公司拥有海外各大学样板无数，能完美还原。
1:1完美还原海外各大学毕业材料上的工艺：水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠。文字图案浮雕、激光镭射、紫外荧光、温感、复印防伪等防伪工艺。材料咨询办理、认证咨询办理请加学历顾问Q/微741003700
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一.毕业证【q微741003700】成绩单、使馆认证、教育部认证、雅思托福成绩单、学生卡等！
二.真实使馆公证(即留学回国人员证明,不成功不收费)
三.真实教育部学历学位认证（教育部存档！教育部留服网站永久可查）
四.办理各国各大学文凭(一对一专业服务,可全程监控跟踪进度)
如果您处于以下几种情况：
◇在校期间，因各种原因未能顺利毕业……拿不到官方毕业证【q/微741003700】
◇面对父母的压力，希望尽快拿到；
◇不清楚认证流程以及材料该如何准备；
◇回国时间很长，忘记办理；
◇回国马上就要找工作，办给用人单位看；
◇企事业单位必须要求办理的
◇需要报考公务员、购买免税车、落转户口
◇申请留学生创业基金
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
Unlocking the Secrets of IPTV App Development_ A Comprehensive Guide.pdf
With IPTV apps, you can access and stream live TV, on-demand movies, series, and other content you like online. Viewers have more flexibility and customization of content to watch. To develop the best IPTV app that functions, you must combine creative problem-solving skills and technical knowledge. This post will look into the details of IPTV app development, so keep reading to learn more.
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AUT毕业证假文凭【微信95270640】购买（奥克兰理工大学毕业证成绩单硕士学历）Q微信95270640代办AUT学历认证留信网伪造奥克兰理工大学学位证书精仿奥克兰理工大学本科/硕士文凭证书补办奥克兰理工大学 diplomaoffer,Transcript购买奥克兰理工大学毕业证成绩单购买AUT假毕业证学位证书购买伪造奥克兰理工大学文凭证书学位证书,专业办理雅思、托福成绩单，学生ID卡，在读证明，海外各大学offer录取通知书，毕业证书，成绩单，文凭等材料:1:1完美还原毕业证、offer录取通知书、学生卡等各种在读或毕业材料的防伪工艺（包括 烫金、烫银、钢印、底纹、凹凸版、水印、防伪光标、热敏防伪、文字图案浮雕，激光镭射，紫外荧光，温感光标）学校原版上有的工艺我们一样不会少，不论是老版本还是最新版本，都能保证最高程度还原，力争完美以求让所有同学都能享受到完美的品质服务。
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Distal third left femoral shaft fracture with arterial injury
- 1. Distal third Left Femoral Shaft Fracture With Arterial Injury By Muhamad Na’im B. Ab Razak (MD USM) 35 years old lady was a passenger of a palm oil lorry together with another 30 colleagues when the lorry lost control while moving down the hill and skidded into the river. Upon presentation, she was diagnosed with closed fracture of distal third left femoral shaft fracture and was put on skin traction while waiting for definitive management. Vital signs are stable throughout observation. However, close observation of circulation chart shows evidence of acute limb ischemia with coldness of the feet, paraesthesia, prolong capillary refilling, severe pain and pulselessness up to popliteal artery. Hand held Doppler reveals loss of biphasic wave. Emergency wound exploration was done and reveals oblique fracture of distal part of left femoral shaft together with arterial injury. Partial cut of femoral artery beneath the bone fragment was also associated with arterial spasm and minimal thrombus formation. The bone was the fixed with Dynamic Compression plate and followed by removal of clot, trimming of the artery and end to end anastomosis with Dafilon 6-0 followed by four compartment fasciotomy of left leg. Post operatively, weak pulse was felt at Posterior Tibialis Artery/ Dorsalis Pedis Artery and Hand Held Doppler ultrasounds reveals strong biphasic
- 2. wave. One day after operation, patients shows great improvement and on the road of excellent recovery Discussion Distal femur fracture is not common as compared to proximal femur fracture and occurs as a result of high velocity injury or low velocity injury due to pathological or osteoporotic bone. It is often due to injury that occurs with flexion of the knee. Distal femur fracture can either affecting the condyles, metaphysis, diaphysis and with or without articular involvement. Common complication are similar to the proximal femoral shaft fracture which includes hypovolumic shock due to bleedings from perforators artery, mal union, delay union and fat embolism syndrome. In exception to fracture involving the popliteal region, neurovascular involvement are not common and seldomly encountered especially in close fracture. By taking a look at this case, it is unknown the exact mechanism of injury especially since it’s involve a mass number of
- 3. victims. Therefore, vascular injury should not be missed in treating patient with femur fracture even though it is uncommon. Another interesting points to be learned is that, arterial injury may also manifested with large hematoma formation or haemodynamically unstable due to hypovolumic shock. However it is not present in this case as a result of arterial spasm. It is recommended that patient with femur fracture should be monitored with circulation chart which includes the color of the leg, the warmness, capillary refilling time, sensation and pulse. This clinical examination plays a very crucial rule in managing this kind of patient. If in doubt whether the pulse is present or not, hand held doppler can be used to aid in making diagnosis. Rarely, patient may also need further imaging studies including dupplex scan and CT angiogram.