Thursday, September 16, 2010

Compound Comminuted Depressed Frontoorbital Fracture

14yo Malay Boy
No known medical illness

Alleged MVA around 2am early morning
Claimed was MB vs MB (MB loss control & hit the fence, pt was not wearing helmet)
No LOC, noted bleeding from laceration wound over the scalp
No ENT bleed/ othorrhoea/ rhinorrhoea
No vomiting
No seizure
No limb weakness
No SOB/ chest pain/ abdominal pain

Alert, conscious
GCS 15/15
Pupils 3/3 ++

Noted laceration wound (T+S done in HTAR) - about 5cm
Another laceration wound Rt temporal region (T+S done in HTAR) - 4cm

Chest/ pelvic spring done : -ve
No neck tenderness

Noted left UL- on immobilizer

BP 116/68
HR 76

Lungs: clear
P/a: soft, nontender

Power Rt UL/ bilateral LL: 5/5
Sensation intact

CT brain:

CT brain:
Rt frontal depresses skull fracture -involving double table extending to superior orbital wall
No obvious ICB/ EDH/ SDH/ SAH seen
BC intact

Emergency elevation of depressed skull fracture

Frontal bone osteotomy done by neuro team with depressed fracture fragment (Lateral portion of the supraorbital rim) attached on the Rt
Depressed fragment elevated and held in place with 4 hole plate and 3 X 5mm screws

Frotal bone segment replaced and secured with horizontal long 16 hole plate across the R supraorbital rim with 5 X 5mm and 1X 4mm screws

All plates and screws from 1.5mm Walter lawrence system - straight reg.

Handed over to neuro team for closure

Post op CT scan:

1 comment:

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