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Morel-Lavallee Lesion Associated with Subtrochanteric Femur Fracture in a Young Female Resulting in Extensive Soft-Tissue Necrosis and Hypertrophic Non-union Managed with Staged Surgeries and Exchange Nailing: A Rare Injury Pattern and Review of Literature

INTRODUCTION: Morel-Lavallee lesion is a closed degloving soft-tissue injury which occurs as a result of acute traumatic separation of skin and subcutaneous tissue from the underlying fascia and muscle layer. The most common sites include thigh (peritrochanteric region), abdomen, scapula, and parasp...

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Autores principales: Mahajan, Neetin P, Kondewar, Pranay, Gadod, Lalkar, Kamble, Mayur, Gund, Akshay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Indian Orthopaedic Research Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9826685/
https://www.ncbi.nlm.nih.gov/pubmed/36659899
http://dx.doi.org/10.13107/jocr.2022.v12.i07.2912
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author Mahajan, Neetin P
Kondewar, Pranay
Gadod, Lalkar
Kamble, Mayur
Gund, Akshay
author_facet Mahajan, Neetin P
Kondewar, Pranay
Gadod, Lalkar
Kamble, Mayur
Gund, Akshay
author_sort Mahajan, Neetin P
collection PubMed
description INTRODUCTION: Morel-Lavallee lesion is a closed degloving soft-tissue injury which occurs as a result of acute traumatic separation of skin and subcutaneous tissue from the underlying fascia and muscle layer. The most common sites include thigh (peritrochanteric region), abdomen, scapula, and paraspinal area. Early diagnosis and management of the lesion is essential so as to prevent complications such as infections or extensive skin necrosis. The management options include conservative or operative depends on extent, location of lesion, and duration since injury. For the management of underlying fracture, one should take into the consideration, the soft tissue compromises which can occur if lesion is large at presentation and plan accordingly for either primary definitive fixation or staged surgeries as necessary. CASE REPORT: A 25-year-old female patient presented with pain and swelling over the anterolateral aspect of the right thigh after a traumatic road traffic accident 2 days back. On radiological investigation, there was subtrochanteric femur fracture with a butterfly fragment. The patient also had Morel-Lavallee lesion on local ultrasound. Emergency management was done for Morel-Lavallee lesion in the form of percutaneous drainage and compression bandage; fixation was done in the form of external fixator. The wound progressed into complete skin necrosis so external fixator was removed and thorough wound debridement was done. Fracture stabilized with four TENS nails (titanium elastic nail). Removal of the TENS nail and exchange nailing in the form of intramedullary interlocking nail was performed after complete soft-tissue healing. Bony union seen at the fracture site clinically and radiologically at 3-month follow-up. CONCLUSION: Initial screening of lesion is very important at time of presentation. Early definitive fixation should not be done if the lesion is large and one should fix the bone once the lesion is resolved.
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spelling pubmed-98266852023-01-18 Morel-Lavallee Lesion Associated with Subtrochanteric Femur Fracture in a Young Female Resulting in Extensive Soft-Tissue Necrosis and Hypertrophic Non-union Managed with Staged Surgeries and Exchange Nailing: A Rare Injury Pattern and Review of Literature Mahajan, Neetin P Kondewar, Pranay Gadod, Lalkar Kamble, Mayur Gund, Akshay J Orthop Case Rep Case Report INTRODUCTION: Morel-Lavallee lesion is a closed degloving soft-tissue injury which occurs as a result of acute traumatic separation of skin and subcutaneous tissue from the underlying fascia and muscle layer. The most common sites include thigh (peritrochanteric region), abdomen, scapula, and paraspinal area. Early diagnosis and management of the lesion is essential so as to prevent complications such as infections or extensive skin necrosis. The management options include conservative or operative depends on extent, location of lesion, and duration since injury. For the management of underlying fracture, one should take into the consideration, the soft tissue compromises which can occur if lesion is large at presentation and plan accordingly for either primary definitive fixation or staged surgeries as necessary. CASE REPORT: A 25-year-old female patient presented with pain and swelling over the anterolateral aspect of the right thigh after a traumatic road traffic accident 2 days back. On radiological investigation, there was subtrochanteric femur fracture with a butterfly fragment. The patient also had Morel-Lavallee lesion on local ultrasound. Emergency management was done for Morel-Lavallee lesion in the form of percutaneous drainage and compression bandage; fixation was done in the form of external fixator. The wound progressed into complete skin necrosis so external fixator was removed and thorough wound debridement was done. Fracture stabilized with four TENS nails (titanium elastic nail). Removal of the TENS nail and exchange nailing in the form of intramedullary interlocking nail was performed after complete soft-tissue healing. Bony union seen at the fracture site clinically and radiologically at 3-month follow-up. CONCLUSION: Initial screening of lesion is very important at time of presentation. Early definitive fixation should not be done if the lesion is large and one should fix the bone once the lesion is resolved. Indian Orthopaedic Research Group 2022-07 2022-07 /pmc/articles/PMC9826685/ /pubmed/36659899 http://dx.doi.org/10.13107/jocr.2022.v12.i07.2912 Text en Copyright: © Indian Orthopaedic Research Group https://creativecommons.org/licenses/by-nc-sa/3.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Mahajan, Neetin P
Kondewar, Pranay
Gadod, Lalkar
Kamble, Mayur
Gund, Akshay
Morel-Lavallee Lesion Associated with Subtrochanteric Femur Fracture in a Young Female Resulting in Extensive Soft-Tissue Necrosis and Hypertrophic Non-union Managed with Staged Surgeries and Exchange Nailing: A Rare Injury Pattern and Review of Literature
title Morel-Lavallee Lesion Associated with Subtrochanteric Femur Fracture in a Young Female Resulting in Extensive Soft-Tissue Necrosis and Hypertrophic Non-union Managed with Staged Surgeries and Exchange Nailing: A Rare Injury Pattern and Review of Literature
title_full Morel-Lavallee Lesion Associated with Subtrochanteric Femur Fracture in a Young Female Resulting in Extensive Soft-Tissue Necrosis and Hypertrophic Non-union Managed with Staged Surgeries and Exchange Nailing: A Rare Injury Pattern and Review of Literature
title_fullStr Morel-Lavallee Lesion Associated with Subtrochanteric Femur Fracture in a Young Female Resulting in Extensive Soft-Tissue Necrosis and Hypertrophic Non-union Managed with Staged Surgeries and Exchange Nailing: A Rare Injury Pattern and Review of Literature
title_full_unstemmed Morel-Lavallee Lesion Associated with Subtrochanteric Femur Fracture in a Young Female Resulting in Extensive Soft-Tissue Necrosis and Hypertrophic Non-union Managed with Staged Surgeries and Exchange Nailing: A Rare Injury Pattern and Review of Literature
title_short Morel-Lavallee Lesion Associated with Subtrochanteric Femur Fracture in a Young Female Resulting in Extensive Soft-Tissue Necrosis and Hypertrophic Non-union Managed with Staged Surgeries and Exchange Nailing: A Rare Injury Pattern and Review of Literature
title_sort morel-lavallee lesion associated with subtrochanteric femur fracture in a young female resulting in extensive soft-tissue necrosis and hypertrophic non-union managed with staged surgeries and exchange nailing: a rare injury pattern and review of literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9826685/
https://www.ncbi.nlm.nih.gov/pubmed/36659899
http://dx.doi.org/10.13107/jocr.2022.v12.i07.2912
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