An unconventional therapy of a subtrochanteric fracture in a Jehovah Witness
C. Rusan1, I. Acalovschi2, D. Lucaciu3, A. Molnar4, S. Hopulele3
1. Secţia ATI, Clinica de Ortopedie şi Traumatologie Cluj-Napoca
2. Clinica de Anestezie şi Terapie Intensivă Cluj-Napoca
3. Catedra de Ortopedie şi Traumatologie, U. M. F. „Iuliu Haţieganu”, Cluj-Napoca
4. Clinica de Chirurgie Cardiovasculară, Cluj-Napoca
Abstract
A 67 year old Jehova Witness patient was admitted with a three week old comminuted subtrochanteric fracture. Associated pathology: secondary anemia (Ht 18%, Hb 6,3 g/l), chronic myocardial ischemia, angina pectoris, chronic atrial fibrilation.
The proposed surgical technique: open reduction and internal fixation with blade-plate and screws.
Case particularities: surgical intervention with increased blood loss and difficult or impossible hemostasis, severe secondary anemia, associated cardiac pathology, denial of transfusion due to religious beliefs.
Several methods to solve the case were discussed: closed reduction of the fracture, controlled hypotension anesthesia technique, blood recirculation, autotransfusion, the use of erithropoetine. The final conclusion was that none of these methods was sufficient to solve the problem. The unconventional idea of clamping the femoral common artery emerged as a possible solution. This method, in fact a selective tourniquet, permitted the surgical procedure in spinal anesthesia with minimal blood loss, the patient being haemodinamically stable during and after surgery, without any other complications. The patient was discharged ten days later and solid bone consolidation occurred in two months.
Key words: Jehova Witness, subtrochanteric fracture, clamping of femoral artery
Soluţie terapeutică neconvenţională pentru un martor al lui Jehova cu fractură subtrohanteriană cominutivă veche, cu deplasarea fragmentelor osoase
Jurnalul Român de Anestezie Terapie intensivă 2004 Vol.11 Nr.2, 137-140
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