Reverse oblique proximal femoral fracture in dystrophic epidermolysis bullosa: challenges and recommendations

A 35-year-old woman attended the emergency department after sustaining a reverse oblique proximal femur fracture, which was amenable to intramedullary nailing. Her presentation was complicated by a background of severe generalised recessive dystrophic epidermolysis bullosa, with extensive blistering...

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Bibliographic Details
Published in:BMJ case reports 2021-01, Vol.14 (1), p.e238483
Main Authors: Giannoudis, Vasileios P, Panteli, Michalis, Aderinto, Joseph, Giannoudis, Peter V
Format: Article
Language:English
Subjects:
Accidental Falls
Adhesives
Adult
Anemia
Anti-Bacterial Agents - therapeutic use
Bandages
Case Report
Case reports
Dermatology
Epidermolysis Bullosa Dystrophica - complications
Epidermolysis Bullosa Dystrophica - therapy
Female
Femoral Neck Fractures - complications
Femoral Neck Fractures - surgery
Fracture Fixation, Internal - methods
Fractures
Hematology
Hemoglobin
Humans
Medical dressings
Narcotics
Open Fracture Reduction - methods
Ostomy
Pain
Patient Positioning
Perioperative Care - methods
Surgeons
Surgical Wound Infection - prevention & control
Wool
Wound Closure Techniques
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Summary:A 35-year-old woman attended the emergency department after sustaining a reverse oblique proximal femur fracture, which was amenable to intramedullary nailing. Her presentation was complicated by a background of severe generalised recessive dystrophic epidermolysis bullosa, with extensive blistering of most of her skin, including the area over the standard surgical incision sites. For the successful management of this case, extensive input from the multidisciplinary team was required, with the team facing several challenges. The whole approach to nursing and surgical management (anaesthesia, positioning, fracture reduction and wound care) had to be modified, taking great care to protect the skin at any cost, therefore reducing the risk of a surgical site infection which would be catastrophic. The management of this patient can set a framework that can be followed in similar cases, aiming for a favourable outcome of such challenging, rare conditions.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2020-238483