HFB3228 Advanced Paramedic Practice 2
Case Study 1
Q1. This film is a radiographic x-ray of a fractured femur. The view is anteroposterior plane (AP). It shows the left pelvis, left hip, left femur and left patella. The patient is a pediatric patient, as you can clearly see the growth plates at the distal end of the femur. You can also see that the hip joint is not completely formed and this is an indication that the patient is pediatric. This is a trauma case. It requires a certain amount of force and trauma to fracture a femur as it is the strongest bones in the body. Q2. This film shows a mid-shaft, oblique fracture of the left femur. The middle third is the most common site of femoral shaft fractures, as the bones anterolateral bowing is at its maximum. Femoral shaft fractures are categorized based on their pattern, degree of comminution, and soft-tissue disruption, if open. Fractures can be transverse, oblique, or spiral (Hakala & Blanco 2000). This fracture is an oblique fracture as the bone is broken on an angle; this is normally a result of indirect trauma. It is also a closed fracture as the bone has not broken through the skin. This fracture is only slightly displaced. The amount of displacement depends on the breaking force, the pull of the muscles and gravity.
Q3. Femoral shaft fractures in pediatrics are often linked with unintentional trauma; however child abuse must be taken into consideration, especially in children who are less than one year old (Anglen & Choi 2005). Up to 30% of femoral shaft fractures in children younger than four years of age may be the result of child abuse, and is the most common cause of femur fracture in infants (Hakala & Blanco 2000). Other signs to look out for that may suggest child abuse are; bruising, burns and other fractures at several phases of healing.
Unintentional trauma that could cause a child’s femur to fracture include; falls, for example falling of the playground; sporting accidents...
References: Ambulance Victoria. (2009). Clinical practice guidelines for ambulance and MICA paramedics, revised edition. Doncaster, Victoria. National Library of Australia Cataloguing-in-Publication Data.
Anglen, J. O. & Choi, L. (2005). Treatment options in pediatric femoral shaft fractures. Journal of Orthopaedic Trauma, 19(10), 724-733.
Hakala, B. E. & Blanco, J. S. (2000). Pediatric femoral shaft fractures. Medscape General Medicine, 2(1).
Owen, J. L., Stephens, D. & Wright, J. G. (2007). Reliability of radiographic measurement of fracture angulation in children with femoral shaft fractures. Canadian Journal of Surgery, 50(2), 115-118.
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