Hey friends, and welcome back to Diagnose This! Hope your week has been successful and that your long weekend proved to be fruitful and as educational as possible.
Now, let us delve back into the depths of memory to remember last week’s case of the unfortunate man with the rather nasty fracture of the femur. Just to confirm for the readers out there who may not know: A FRACTURE AND A BREAK ARE EXACTLY THE SAME THING. I have been in arguments with people for the past 6 or so years about this, and can definitely confirm that I have been right. So yeah, take that people in high school who didn’t believe me. (I promise I don’t hold grudges…)
Now then, sorry for that little detour, back to the case. Describing this to the orthopaedic consultant may seem confronting and scary at first, but if you follow this simple acronym you can wow those consultants and get those brownie points: OLDACIDS. It stands for Open/closed, Location, Degree (complete vs incomplete), Articular involvement, Comminuted/type, Intrinsic bone quality, Displacement/angulation/rotation, and Soft tissue injury. In this case, the following description can be made: “This is a closed fracture of the distal third of the femur. It appears complete and there does not appear to be any articular involvement. This is a comminuted fracture (indicated by the splinters of the bone) and the intrinsic bone quality appears normal. There is 100% displacement with approx 15 degrees of angulation, with rotation only being assessed upon inspection of the patient, and there does not appear to be any soft tissue damage.” Treatment option, according to BMJ Best Practice (2015), Immobilisation with either intramedullary, antegrade, or retrograde nailing depending on what the surgeon decides. Finally, if this injury was obtained through a relatively minor trauma, the condition that we would want to rule out the most is an osteosarcoma of the femur; a nasty cancer that has the potential to cause pathological fractures (not caused by trauma).
Sorry for the long case description guys, but hopefully you all gained something from it!
Now then, to celebrate St Patrick’s Day we have a very special Diagnose This that will (hopefully!) not happen to any of you this weekend!
A 19 year old male is brought into the ED after a night of incredibly heavy drinking. The patent is still quite intoxicated, but he seems to think he has consumed “like, 13 or 14 beers and some pretty awesome apple schnapps shots”. He says this right before throwing up all over your brand new Italian leather shoes. He is experiencing pain that radiates to his back and has both a positive Grey-Turner’s and Cullen’s sign. He is tachycardic, tachypnoeic, and hypertensive.What is your main differential, what investigations should be performed to rule in/out your differentials, and what are the causes of this condition? (Hint; a handy mnemonic may help here!)
Tune in next week for the answers, and have some fun (and safe!) St Patrick’s Day celebrations!
This year, over 12 million pints of Guinness were consumed on St Patrick’s Day! Nice to know that we here at bloodbonesandbodies have contributed to such a valuable statistic.
Picture from http://www.amazon.com/Guinness-Poster-Print-24×36/dp/B004VMO5M2