Anesthesia management of bilateral femur shaft fracture and left tibiofibular fracture for bilateral sign nail and tibiofibular sign with cervical spine injury and epidural hematoma: a case report

Abstract

Preoperative evaluation by an anesthetist must be performed since 70% of patients with a femur fracture will have an American Society of Anesthesiologists (ASA) score of III to IV. Although they occur rarely between 1 and 7%, bilateral femur fractures are linked to significant morbidity and mortality. Previous reports have described anesthetic management for aged patients who have bilateral femur fracture is difficult and needs team and increased perioperative complications. This case emphasizes the necessity to prepare adequately and improve knowledge and awareness of anesthetic management of patients for bilateral femur fracture and tibiofibular fracture for aged patients and needs multidisciplinary team to cooperate and increase the positive outcome of the patients. Patients with these conditions may present with various sign and symptoms that complicate the administration of anesthesia. Decisions regarding when to operate either before resuscitation or after the patient is resuscitated are one area of concern and consider preserving organ damage from secondary complications and maintain hemodynamic stability to ensure the anesthesia management is optimal and to increase the good outcomes of the patient. Case report: A 50 year old male presented with bilateral femur shaft fracture and left tibiofibular fracture following road traffic accident and was planned for bilateral sign nail and left tibiofibular sign. Patient has cervical spine injury and epidural hematoma. Patient has undergone general anesthesia with endotracheal tube. Conclusion: We present a successful anesthetic management of patients who had bilateral femur fracture and left tibiofibular fracture with cervical spine injury and epidural hematoma. We emphasize the risk of neurological injury while extending the neck during laryngoscopy for tracheal intubation due to cervical spine injuries and we preferred to general anesthesia over spinal anesthesia due to contraindicated for spinal anesthesia in these patients. A detailed pre anesthetic evaluation and multidisciplinary approach as well as planning is utmost important and the anesthetic technique has to be individualized based on the patients anatomical characteristics and associated co-morbidities.