Nursing care of Close Fracture left Tibia with Compartment syndrome : Case study

Abstract

A case study of thai female patient 43 years old. Accidents occurred while driving motorcycle crashing the dog 10 minute before coming to the hospital. She was unconscious can’t remember event. She had laceration wound on the face, left leg was swollen, deformed and pain. Patient was conscious at emergency room x- ray left leg was done. X-ray resulted comminuted fracture of left tibia plateau extended to proximal tibia. Doctor diagnosed closed fracture left tibia plateau with proximal tibia with mild head injury. Left leg was on splint and put a philadellphia collar on her neck. Admit at Accident surgery ward. Form the frist day of receiving doctor wearing calcaneus traction in the left ankle weighted 5 kg can feel dorsalis pedis pulse and poplitial pulse clearly.  Capillary refill = 2 second. Left leg was swalling and pain (pain score = 8-10) doctor give periodic pain medication. Patient had no urination symtom doctor put a urinary catheter. Pateint admitted to observe sign and symtom at the Accident surgery ward for 24 hours without any abnormal move to stay in the Pakansungkom ward. Doctor performed surgery for open reduction internal fixation with plate inserted at tibia plateau. After operation returned to Pakansungkom ward, about  1 hour after return form operation room found that pateint with pain, pain score = 10 pain relief medication. Left leg swallen, can’t feel the instep of pulse. Capillary refill = 10 second. Blood pressure = 110 / 70mmHg compartment pressure was measured for anterior compartment pressure = 40 mmHg and posterior = 60 mmHg. Doctor diagnosed compartment syndrome treated by surgery  fasciotomy and internal fixation with plate insert. Later wound is slightlynnecrosis  surgical debridement and loose suture closure of the fascia. After 3 days doctor sawed wound. Pateint pale get pack red cell 2 Unit for treatment of anemia. Patient was gived antibiotic to combat  infection. The problem and important nursing was that there was high pressure in the left ventricle in left shin bone, risk of infection, risk of complication various before and after. Anxiety in self care at home. The patient was hospitalized for 17 days. The doctor allowed to go home. Before going home patient can walk with crutches and knees can be improved.