Management of long bone fractures in patient with cerebral f
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Case 1 is an 18-year-old male who presented with an open midshaft tibia and fibula fracture. The initial Glasgow Coma Score (GCS) was 15. He underwent emergent irrigation and debridement (I&D) with external fixation. Postoperatively, he was not arousable and had a depressed mental status with a GCS of 5, decerebrate posture, leftward gaze preference, and nystagmus. Magnetic resonance imaging (MRI) of the brain demonstrated multiple foci of punctate abnormality consistent with cerebral FES. The patient remained intubated and was given supportive care. One month after injury, he underwent removal of the static external fixator and placement of a TSF. The patient had complete resolution of all neurologic symptoms and had TSF removed 6 months postoperatively. By one year postoperatively, he returned to normal cognitive and physical function.

Case 2 is a 26-year-old female who presented with bilateral open comminuted femoral shaft fractures and a segmental humeral shaft fracture. Upon arrival, she was intubated and had a GCS of 3 with improvement to 11 after trauma resuscitation protocols. The patient underwent I&D, wound closure, bilateral external fixation of the femur fractures and splinting of the left humerus. The patient had a gradual decline of GCS through postoperative day 3. MRI of the brain showed multiple emboli compatible with cerebral FES. The patient underwent repeat I&D, ORIF with SMP, and antibiotic bead placement for her left femur fracture on postoperative day 6. Four days later, she underwent ORIF with SMP of her right femur. She had ORIF of her left humerus four days after. The patient had complete resolution of all neurologic symptoms by 1 month postoperatively and was discharged to rehab.

Source: https://www.sciencedirect.com/science/article/pii/S2352644020300893?dgcid=rss_sd_all
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